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SayPro Emergency Needs Assessment Form For evaluating community needs before dispatch
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Certainly! Below is a professional and structured SayPro Emergency Needs Assessment Form, designed to be used before dispatching emergency supplies as part of the SayPro Monthly Resource Distribution campaign. This form ensures accurate evaluation of local needs, helping SayPro make informed, targeted decisions in alignment with the SayPro Development Royalty framework.
SayPro Emergency Needs Assessment Form
Program Reference: SayPro Monthly [Month] SCDR-[Number]
Form Type: Pre-Dispatch Community Needs Evaluation
Conducted By: SayPro Community Development Office
Under Initiative: SayPro Development Royalty
1. General Information
Assessment Date | [DD/MM/YYYY] |
---|---|
Assessor Name | |
Team ID / Region | [e.g., TEAM-03-GP] |
Community Name | |
Region Code | [e.g., EC-02] |
Municipality / Ward | |
Community Contact Person | [Name, Phone Number] |
2. Community Demographics (Estimate)
Total Households | |
---|---|
Population Estimate | |
Elderly (65+) | |
Children (under 12) | |
Disabled Individuals | |
Pregnant Women |
3. Immediate Needs Assessment
Please check the boxes and provide quantity estimates based on current needs:
Category | Need Identified? | Estimated Quantity Needed | Urgency Level (High/Medium/Low) |
---|---|---|---|
Food (Non-perishable) | [ ] Yes / [ ] No | ||
Clean Drinking Water | [ ] Yes / [ ] No | ||
Hygiene Supplies | [ ] Yes / [ ] No | ||
Sanitary Products | [ ] Yes / [ ] No | ||
Blankets / Warm Items | [ ] Yes / [ ] No | ||
Medical Kits / First Aid | [ ] Yes / [ ] No | ||
Baby Supplies | [ ] Yes / [ ] No | ||
Shelter Materials | [ ] Yes / [ ] No | ||
COVID-19 Protective Gear | [ ] Yes / [ ] No |
4. Observations on Ground Conditions
Check or briefly describe the following:
- Access to Community:
- Fully accessible by road
- Limited access (narrow roads, debris)
- Inaccessible (requires foot access)
- Recent Disruptions:
- Floods
- Fire
- Political unrest
- Service delivery protest
- Health outbreak
- Other: _______________________
- Water & Sanitation Status:
- Functioning
- Partially functioning
- Not functioning
- Medical Access:
- Clinic nearby
- Mobile services required
5. Community Feedback (Optional)
Please capture any direct input from local leaders, caregivers, or residents regarding urgent needs or recent hardships:
“Residents report that clean water has not been available for 10 days due to a broken pump. Children are showing signs of malnutrition…”
6. Assessment Summary and Recommendation
Summarize key findings and your recommended type and quantity of supplies for this community:
This community urgently requires food supplies (approx. 120 parcels), sanitary products, and water purification tablets. Recommend dispatch under high-priority within 48 hours.
7. Assessor Sign-Off
Assessor Name | |
---|---|
Signature | ____________________________ |
Date of Submission | [DD/MM/YYYY] |
8. Review & Approval (Internal Use Only)
Reviewer Name | |
---|---|
Role / Region | |
Approved for Dispatch? | [ ] Yes / [ ] No |
Signature | ____________________________ |
Date Approved | [DD/MM/YYYY] |
Submit completed forms to SayPro Community Development Office via the SayPro Logistics Portal or email to: logistics@saypro.org
Would you like this form as a fillable PDF, Word document, or Google Form for digital data collection in the field?
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