NEPP Survey Neighbourhood Emergency Preparedness Plan Your HouseholdAddress Street Address City State / Province / Region ZIP / Postal Code Inhabitants of HouseholdPeopleFirst NameLast NamePhoneEmailC-MIST Needs Click the + button to enter more people.See descriptions of the C-MIST Needs: Yes No The C-MIST approach is based on a “Functional Needs Framework”. It identifies people’s actual needs during an emergency rather than labeling them as “special needs”. It is considered more inclusive as it identifies people with temporary needs or those who do not identify themselves as having a disability. People have limitations in the areas of seeing, hearing, speaking, moving, breathing, understanding and learning. For the purposes of emergency preparedness and response, “needs” are organized into 5 categories: C Communication, M Medical, I Independence, S Supervision and T Transportation (C-MIST). Each category has its’ own icon for easier identification and more detail is given below. Communication: This category includes people who have limited or no ability to speak, see, hear or understand. During an emergency, people with communication needs may not be able to hear announcements, see signs, understand messages or verbalize their concerns. Medical: People in this group require assistance in managing activities of daily living such as eating, dressing, grooming, transferring and going to the toilet. It includes managing chronic, terminal or contagious health conditions (such as ongoing treatment and administration of medications, IV therapy, catheters, tube feeding, dialysis, oxygen, operating life sustaining equipment...) During an emergency, people may be separated from family and friends. Early identification of these needs and intervention can avoid deterioration of health. Independence: This includes people who can function independently if they have their assistive devices and/or equipment. Items consist of mobility aids (such as wheelchairs, walkers, canes, crutches); communication aids; medical equipment, (such as catheters, oxygen, syringes, medications); and service animals. Individuals may become separated from their assistive equipment and/or animals in an emergency. Those at risk whose needs are recognized and restored early can maintain their independence and manage in mass shelters. Effectively meeting their functional needs prevents secondary complications. Supervision: People with supervision needs may include those who have psychiatric conditions (such as dementia, Alzheimer, Schizophrenia, depression or severe mental illness); addiction problems; brain injury or become anxious due to transfer trauma. During an emergency, some people with mental illness may be able to function well while others require a more protected and supervised setting. Transportation: Emergency response requires mobility and this category includes people who are unable to drive because of disability, age, temporary injury, poverty, addiction, legal restriction or have no access to a vehicle. Wheelchair accessible transportation may be necessary. Pre-planning evacuation needs help prevent chaos during an emergency and many people can function independently once evacuated to safety. PetsNameTypeAggression Level (ex. Mandy - Dog - Friendly) ----- Click the + button to enter more pets.Other InformationDoes your home have a Personal Emergency Preparedness Kit?*- SELECT -YESNOFor more information visit https://www.panoramaridge.org/initiatives/neppWould you be interested in joining our volunteer team either for planning or for support during an emergency?*- SELECT -YESNOFor more information visit https://www.panoramaridge.org/initiatives/neppPersonal SkiilsSkills you can contribute to help in emergencies. Complete this section if you answered 'Yes' to joining our volunteer teamMedical/First Aid- SELECT -GoodVery GoodExcellentMedical/First Aid Details*Hands-on/Heavy Lifting- SELECT -GoodVery GoodExcellentHands-on/Heavy Lifting Details*Electrical Work- SELECT -GoodVery GoodExcellentElectrical Work Details*Gas Work- SELECT -GoodVery GoodExcellentGas Work Details*Organization/Leadership- SELECT -GoodVery GoodExcellentOrganization/Leadership Details*Caretaking- SELECT -GoodVery GoodExcellentCaretaking Details*Scouting/Search & Rescue- SELECT -GoodVery GoodExcellentScouting/Search & Rescue Details*Communications- SELECT -GoodVery GoodExcellentCommunications Details*Other- SELECT -GoodVery GoodExcellentOther Details*Limiting factors*Note any limiting factors on the above (i.e. job or family obligations, etc)Accessible Equipment ResourcesResources you could contribute in the event of an emergency.Resources you can contribute Medical/First Aid Fire Extinguisher Tools Tarps/Tents Heater/Gas Fire Pit/Generator Fuel Care Taker Supplies Camping Gear Communication/2-way Radio Transportation Vehicles Other Medical/First Aid Resource Details*Fire Extinguisher Resource Details*Tools Resource Details*Tarps/Tents Resource Details*Heater/Gas Fire Pit/Generator Resource Details*Fuel Resource Details*Care Taker Supplies Resource Details*Camping Gear Resource Details*Communication/2-way Radio Resource Details*Transportation Vehicles Resource Details*Other Resource Details*CommentsThis field is for validation purposes and should be left unchanged.