Organizational Capabilities Assessment

Organization Type: Faith-Based Organization UPCI Community Based Organization

Number of Members Total:

Does your organization have a Disaster or Emergency Plan in place?

Yes No

What services/resources do you provide on a daily basis to your members or community?

Child Care Clothes Distribution Commercial Kitchen Community Center Counseling Food/Commodities Pantry Medical Services Security Shelter Transportation Disability Access Other

Would your organization be willing to provide any of these services in an emergency? Yes No

How is your facility/organization equipped to fulfill the services that you provide? (e.g., space, kitchen, equipment)

Do you have space to temporarily store product in preparation for distribution? (church hallways, gymnasiums, fellowship halls, or other buildings/space)

Yes No

Any chance you have access to a borrowed/owned warehouse space of 5,000 to 10,000 square feet? (if not, that's okay)

Yes No

Do you have a space with a dock for the unloading of a semi-truck? (if not, that's okay)

Yes No

Is your facility equipped with a generator? Yes No

Please provide information regarding the occupations and skills of members of your organization who may be able to serve the community in a crisis (please note any training or certifications obtained, as applicable/available):

Chaplain / Spiritual Care Providers Crisis Counselors Individuals Trained in Cardiopulmonary Resuscitation (CPR)/First Aid Interpreters (please include languages, to include American Sign Language) Medical Doctors Nurses / Licensed Vocational Nurses Paramedics/ Emergency Medical Technicians Retired Public Safety Personnel Teachers/Child Care Veterinarian or Animal Care Services Other (e.g., amateur radio operators)

Does your organization have the ability to distribute food or other commodities to the community during a small or large-scale incident? 1- Small Scale Incident 2 3 4 5- Large Scale Incident

If yes, how many meals can your organization prepare and serve each day?

Does your organization have the ability to deliver food? Yes No Option

Does your organization have a shelter space available for use during a small or large-scale incident? Yes No

If yes, what is the size (including square footage) and type of space that is available for sheltering?

How many people can be sheltered?

Can people with disabilities and others with access and functional needs use this facility? Yes No

Are non-service animals permitted in or around the shelter space?

Yes No

Does your organization have a licensed or certified childcare facility? Yes No

If yes, is your organization willing to serve community members and children who need assistance following an incident? Yes No

What is your maximum childcare capacity?

Can your organization provide mental, emotional counseling during a small or large-scale incident? Yes No

If yes, how many licensed/certified/trained counselors will your organization be able to provide?

Does your organization have a communication system to activate in response to a small or largescale incident? Yes No

If yes, what type of system do you have (e.g., amateur radio, phone tree)?

Who does the system reach (e.g., community members, employees)?

Does your organization accept donations? Yes No

If yes, what type (e.g., food, clothing, money)?

Does your organization distribute donations through case management? Yes No

Does your organization have the ability to mobilize volunteers to assist the community during a small or large-scale incident? Yes No

If yes, how many volunteers could your organization provide at one time?

Are there additional services that your organization would be able to provide during a small or large-scale incident?

What type of assistance do you believe your organization will need to prepare in advance for organizational preparedness/continuity? Communications Developing Partnerships Donations Management Mass Care Feeding Organizational Preparedness/Continutity Service Coordination Sheltering Spiritual and Emotional Care/Counseling

What type of assistance do you believe your organization will need to respond to or recover from a small or large-scale incident (e.g., debris removal, interpreters)?

Are you a part of, or aware of, other organizations/networks that provide similar community services? Yes No

Organizational Capabilities Assessment

Description

Please Fix the Following