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SayPro Emergency Needs Assessment Form  For evaluating community needs before dispatch

SayPro is a Global Solutions Provider working with Individuals, Governments, Corporate Businesses, Municipalities, International Institutions. SayPro works across various Industries, Sectors providing wide range of solutions.

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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:

CategoryNeed Identified?Estimated Quantity NeededUrgency 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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