Caldor Fire Survivor Spring/Summer 2023 Questionnaire

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Names of those living in household with you
5
Current Physical Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Current Mailing Address* This field is required.If different than physical address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Are you planning on returning to your property?* This field is required.Help us understand what you are on planning on doing with your property. This helps us understand how many households are returning, planning on returning, or unsure about returning to the Grizzly Flats area. Plus, it helps us understand how many households are planing to or have moved on.
Yes
No, but keeping the property
Already on property
No, sold or selling property
Unsure
8
If unsure, please explain the uncertainty.* This field is required.We may be able to help direct you to resources.
9
Current Living Situation* This field is required.Help us understand your current living situation.
Living in RV on my property
Living in RV on another property
Rebuilt or back in home
Renting room/apartment/house
Living with family/friends
I do not have a stable living situation
10
Rebuild Status* This field is required.Help us understand where you are on your rebuild journey.
I am completely rebuilt or in a new home
I am in the building/delivery set up process and will be back in our homes within 1-3 months
I am starting the building/delivery and set up process in the next 1-3 months
I am starting the building/delivery and set up process in the next 6-9 months
I am starting the building/delivery and set up process in the next 9-12 months
I am getting everything prepared to start rebuilding process in 2023
I am ready but I do not know where to start
I do not have the funding needed to rebiuld
Other
11
What type of rebuild are you considering or have chosen to go with?* This field is required.
Stick Build
Mobile Home
Modular Home
Kit Home
Tiny Home
Unsure
Other
12
Needed Items* This field is required.Help us understand your individual and household needs. Your answers will help us go after funding or resources to assist in fulfilling the needs requests.
13
Are there any resources you need or could use help with?* This field is required.For example: rebuild navigation, insurance navigation, health and human services/mental health, etc.
14
Does this apply to you?* This field is required.
YESNO
15
What good or service did/do you sell or create?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
16
Upload any images or files explaining/showing the good or service you sold or created?
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
Did you lose the items you used to create or sell your goods or services?* This field is required.
Yes, lost everything
Lost some
Lost mostly everything
I was able to save everything I needed to continue my craft or trade
18
What tools or supplies would you need to restart your home business?* This field is required.Please be specific
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Large
Normal
Small
Ok
Ok
19
Would you be interested in selling your goods or services at craft fairs, artisan centers, or local events?* This field is required.
Yes, I am ready
Yes, if I were given the space and/or tools needed to create my craft again
No
Other
20
Do you have a disaster plan for your household?* This field is required.
Yes, GoBags are ready and I know the different evacuation routes in my area
Yes, I know what I would grab if I had to evacuate again, but I do not have anything pulled together
No, I am not prepared if I had to evacuate again
I would like to receive information on how to become better prepared if faced with another evacuation
Other
21
Does your disaster plan include enough supplies for 72 hours for each of the members in your household?* This field is required.Food, water, warmth, basic first aid, etc.
YESNO
22
Does your disaster plan include your animals and /or livestock?* This field is required.
Yes
No
I am working on including all of our animals in our disaster plan
23
If no, what do you need to get better prepared? * This field is required.GoBags, educational information, insurance help, hands on training, etc.
Huge
Large
Normal
Small
Ok
Ok
24
What tools or services would have helped you and your household when you were evacuating from the Caldor Fire?* This field is required.Checklists, evacuation outlines, better communication, etc.
Huge
Large
Normal
Small
Ok
Ok
25
Have you registered with Code Red?* This field is required.Visit, https://ready.edso.org/ to sign up to receive emergency information from our county.
YESNO
26
Do you have an alternate way to receive information if cell phones were down?* This field is required.
Yes, emergency radio, HAM radio, etc.
No
I would be interested in learning more about other forms of information receiving technology
Other
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