Maresfield Parish Council

Civil Emergency Questionnaire

Please let us know if you could help , or may need help , in an emergency.

Please fill in the form below to submit to the Parish Council.

All information supplied is confidential and will not be disclosed to any third parties.

 

20/09/2010

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Please input your name

Please input your address or contact information - email , telephone

Skills

 First Aid  Nursing  Medical/Doctor  HGV/Tractor  Contracting  Plumbing 

Electrical  Tree Surgeon  Vehicle Mechanic  Veterinary Experience 

Police Active/retired  Fire Active/retired   Catering  Radio operating 

   

Willing to offer

 Cooking  Staffing shelters  Food distribution Moving people by car 

Moving equipment  Well or spring water  Messenger work  Spare room 

Beds Temporary shelter  Storage space  Earth/tree moving  Wield pick/shovel
   

Equipment

  Tractor  JCB  4WD with trailer Petrol chainsaw  Portable generator 

Multiseat vehicle  Portable cooker Portable barbeque  Diesel or petrol supply 

Solid fuel or bottled gas  Aga or solid fuel cooker  Camp beds  Portable phone  CB radio
   

Mobility/Special Needs

Please tick the boxes to show the type of help you may need 

Any Relevant disability  Any relevant medical condition Live alone

No car  No phone  Other special needs

Please input the details of the needs stated.

Please state if an electricity supply is necessary for equipment or medicine needed for treatment.

If your needs are particularly personal , please feel free to say that you only need personal help.
   

Local risks

If your home or the immediate vicinity is subject to any special local risks, please say so above.

Obvious examples are flooding or forest fire.