CRISIS BUNKER RESILIENCE HUB DISASTER READINESS NEEDS ASSESSMENT

CRISIS BUNKER RESILIENCE HUB DISASTER READINESS NEEDS ASSESSMENT

Please fill out this form to provide necessary information for your Disaster Readiness Project
Name of your Entity (e.g. XYZ Marae)
Where is the location for the disaster readiness project?

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Who is the key contact person (and position) for this project?
Full Name

First NameLast Name
Position (e.g. Chair)
Contact Phone Number
Please enter a valid phone numberFormat: (000) 000-0000.
Email
example@example.com
What are the natural hazards/risks in your location?

Other (Please specify)
Do you have a (current) Emergency Preparedness Plan?
Who have you engaged with in the preparedness planning process?

Other (Please specify)
Indicate the numbers of people/population that would require support during a disaster.
Do you require a Fixed Location Hub (Shipping Container Based) or Mobile Hub (Trailer)
What disaster preparedness resources do you require?

Other (Please specify)
Would you like your Resilience Hub to remain powered during outages with solar panels and backup power?
Would you like your marae or organisation’s logo displayed on your Resilience Hub to reflect your community?
Will you require funding application assistance/advice from Crisis Bunker for your disaster preparedness project?
Should be Empty:

Who is the key contact person (and position) for this project?