Identification | Entered by (name) | | Mike |
Name(s) and age(s) of individual(s) at location being described (list primary contact person first) | | completing |
Contact info and preferred method (phone #, email address, etc) | | |
Organization of person being surveyed (if appropriate) | | |
Type of location being descibed | | |
Other | |
Location name (if appropriate) | | |
Size of population covered by survey | | |
Street Address | | |
City | | |
Location | | 40.634258678134394;-73.89776564025885;;NY;US;11236 |
NEIGHBORHOOD RESILIENCE ASSESSMENT |
HOUSING:
How secure and safe do people feel in their homes? (1 not safe at all – 7 perfectly safe)
| | 4 [A4] |
2.1 ENERGY / TEMPERATURE MANAGEMENT:
To what degree are people able to keep warm in cold conditions and keep cool in hot conditions? (1 not capable at all – 7 fully capable)
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2.2 ENERGY / ELECTRICITY:
To what degree do people have access to sufficient and reliable electricity? (1 no access at all - 7 sufficient access to answer all their needs)
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3. WATER:
To what degree do people have access to drinking water in sufficient quantity and satisfactory quality? (1 no access at all - 7 sufficient access to answer all their needs)
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4.1 WASTE MANAGEMENT / SOLIDS:
What is the reliability of the solid waste management (trash removal, recycling, etc)? (1 no reliability at all – 7 complete reliability)
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4.2 WASTE MANAGEMENT / SEWAGE:
What is the reliability of the human waste management and sewage systems? (1 no reliability at all – 7 complete reliability)
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5. FOOD SECURITY:
To what degree do people have access to food in sufficient quantity and satisfactory quality? (1 no access at all - 7 sufficient access to answer all their needs)
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6.1 SUPPLY CHAINS / RELIABILITY :
To what degree are the community's supply chains sufficient, reliable and stable? (1 not at all sufficient, reliable and stable – 7 very sufficient, reliable and stable )
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7.1 HEALTH / ENVIRONMENTAL HEALTH AND SAFETY:
To what degree are people able to maintain their living and working environment free from mold growth and other hazards? (1 not capable at all – 7 fully capable)
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7.2 HEALTH / HYGIENE AND PREVENTION:
How effective and widespread are good practices in hygiene and disease prevention in the neighborhood? (1 no good practices at all – 7 perfectly effective practices)
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7.3 HEALTH / HEALTH SERVICES:
To what degree are quality health care services being provided at an affordable cost in the neighborhood? (1 no quality and affordable healthcare at all - 7 sufficient quality and affordable healthcare)
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8.1 ECONOMY / VIABLE VALUE CHAINS: To what degree are people free from economic challenges? (1 a lot of economic challenges – 7 no economic challenges at all)
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8.2 ECONOMY / LOCAL EMPLOYMENT:
To what degree are people who want to work locally able to access local jobs? (1 no access at all – 7 complete access)
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9. COMMUNICATION SYSTEMS:
To what degree can people communicate effectively with communication and computing devices? (1 no capacity at all – 7 complete capacity)
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10. COMMUNITY / SOLIDARITY:
To what degree does the community reach out to help each other? (1 completely on their own – 7 fully supported by the community)
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11. COMMUNITY / SECURITY:
To what degree does the community feel secure? (1 no security at all - 7 complete security)
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12. COMMUNITY / SERVICES: To what degree are social problems addressed through current services? (1 not addressed at all – 7 fully addressed )
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13. COMMUNITY / COMMONS AREAS: To what degree does the community have the facilities and resources to enable community-based organizations and residents in need to meet and solve problems? (1 no facilities nor resources at all – 7 sufficient facilities and resources)
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14. COMMUNITY / ANCHOR INSTITUTIONS:
To what degree are anchor institutions (e.g. hospitals, colleges, manufacturing, information services) supporting the quality of life, economy and local employment within the community? (1 no support at all – 7 full support)
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15. COMMUNITY / RENEWABLE ENERGY: To what degree is the community moving toward 100% renewable energy? (1 no advancement at all – 7 complete advancement)
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16. COMMUNITY / LOCAL AND HEALTHY FOOD:
To what degree is the community setting up community gardens and local farms to produce food locally? (1 no advancement at all – 7 complete advancement)
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17. EMERGENCY / COASTAL PROTECTION INFRASTRUCTURE: To what degree are there appropriate coastal protection infrastructures in place to protect the community from flooding? (1 no coastal protection at all – 7 perfect coastal protection)
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18. EMERGENCY / SHELTER IN PLACE: In case of a disaster, to what degree would people be able to shelter in their home safely? (1 no capacity at all – 7 full capacity)
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19. EMERGENCY / PLACE TO EVACUATE: In case people need to evacuate their home, to what degree would they have access to nearby, alternative housing? (1 no access at all – 7 full access)
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20. EMERGENCY / MEANS OF EVACUATION: In emergency conditions, to what degree would the community have appropriate access to mass transit or other transportation? (1 no access at all – 7 full access)
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21. EMERGENCY / COMMUNICATION In case of an emergency that compromises central grid communications and computing, to what degree could people still communicate effectively? (1 no capacity at all – 7 full capacity)
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Resident(s) at the location being described would like a referral for case management assistance | Case Management help with (select all that apply) | Housing | |
Environmental health and safety | |
Shelter and evacuation systems | |
Supply chains | |
Energy | |
Food security | |
Clean water | |
Hygiene and prevention | |
Sewer systems | |
Waste management | |
Health services | Yes [Y] |
Psychosocial environment | |
Communication systems | |
Transportation | |
Coastal Protection infrastructure | |
Community security | |
Social services | |
Community commons areas | |
Viable value chains | |
Migration and transformation | |
Other | |
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