After reviewing numerous possible forms, and collecting comments from all who responded, the CERPP Operations Committee has developed the following Rapid Need Assessment Form. Here is a link to the pdf version of the form. RapidNeedsAssessmentForm.pdf

Hear are some instruction for using the form:

Some work still remains to be done including, some artistic touch-up to the icons, and the development of instructions and training material for the Rapid Needs Assessment process. Additionally we will be working on the programming to provide forms that are pre-filled with addresses for each division. See the bottom of the page for our first attempt at this.

Download your division's street address list and Rapid Needs Assessment Forms

Vista Verde div1addresses.csvdiv1.pdf
Los Trancos div2addresses.csvdiv2.pdf
Blue Oaks div3addresses.csvdiv3.pdf
PV Ranch div4addresses.csvdiv4.pdf
Sequoias div5addresses.csvdiv5.pdf
Brookside div6addresses.csvdiv6.pdf
Alpine Hills div7addresses.csvdiv7.pdf
Family Farm div8addresses.csvdiv8.pdf
Westridge div9addresses.csvdiv9.pdf
Ladera div10addresses.csvdiv10.pdf
Woodside South div11addresses.csvdiv11.pdf
Canada East div12addresses.csvdiv12.pdf
The Glens div13addresses.csvdiv13.pdf
Woodside Heights div14addresses.csvdiv14.pdf
Woodside Hills div15addresses.csvdiv15.pdf
Highlands div16addresses.csvdiv16.pdf
Skyline div17addresses.csvdiv17.pdf
Old La Honda div18addresses.csvdiv18.pdf
Skywood Acres div19addresses.csvdiv19.pdf
Bear Gulch div20addresses.csvdiv20.pdf
Woodside West div21addresses.csvdiv21.pdf
Woodside North div22addresses.csvdiv22.pdf
Emerald Hills WS div23addresses.csvdiv23.pdf
Emerald Hills RWC div24addresses.csvdiv24.pdf
Rapley Trail div25addresses.csvdiv25.pdf

Customize your division's Rapid Needs Assessment Forms

Here is our automatic damage assessment form builder. We do not know how your division is broken up into neighborhoods or blocks. You will need to modify the street address list to add in neighborhood or block information. Start with your division's street address list. It is a "comma separated value" file with one line for each address in your division. You can open it in a spread sheet program or in a text editor. Just make sure to save or export it back into a csv file.

Here is a sample file

"=","Division Name/Block or Neighborhood Name"
"123","Any Street"
"124","Any Street"
"125","Any Street"
"126","Any Street"
"=","Division Name/Another Block or Neighborhood Name"
"456","Other Street"
"457","Other Street"
"458","Other Street"
"459","Other Street"
"460","Other Street"
"461","Other Street"

Most of the lines in the file represent addresses in the division. The first column is the street number and the second column is the street name.

The lines that have the equals sign "=" in the first column, start a new page, labeled with the division and block or neighborhood name specified in the second column. Seperate the Division name from the Block name using a forward slash "/".

Export the spread sheet as a CSV file. Follow this link, upload the file, and you get a pdf file with your pre-filled Rapid Needs Assessment Forms.
Rapid Needs Assessment Form Generator

These are some of the forms and comments we used in the process of coming up with our form.

These forms and instructions were used in a 2012 Advanced CERT class we taught.

Someone handed me this form at the meeting in paper format. I've got no other info

Here is the Division 16 form

Here is John's new form

I’ve been working on an updated damage assessment form. I’ve made the line a bit taller to facilitate hand writing info. I’ve gone to icons to help get marks in the correct columns. I’ve gone to 5 damage levels per this FEMA document, page 24. I’ve removed all of the space for “notes”, preferring to indicated notes attached on a separate sheet. I think that will make for much better note taking.

A few of questions from Vicki...
Not sure I totally understand the difference between quick and life safety

“Quick” is what we also call a “Windshield” survey. Each house get only a minute or so of inspection. “Life Safety” is a more detailed survey where we might have time to contact the occupant, do utility shutoffs, look and listen for anyone trapped inside etc.


Since we will be using this with pre-filled addresses, there needs to be a way to indicate the address was actually located and checked. A sheet may not get fully completed or an address may not get checked. “Checked” might be better wording.

This is perhaps my own bent as a doc but there are five house icons and one broken arm. Perhaps the affected could be dropped and that column used to break injuries into minor i.e. broken arm icon and major or life threatening since our first goal is assessing human well being.

I think triage and first aid is a separate task from a damage survey. And a form with one line per address seems like a poor place to try and record extent of injuries to individuals. I pondered leaving it off the form entirely.

A quick survey team is not likely to have time to even locate and triage individual victims. A life safety survey team has time to locate and triage patients. The result of that should probably be direct reporting of immediate triage patients, recruiting/requesting others to assist delayed patients, and directing minor patients to aid stations. All of which likely deserves its own reporting and record keeping forms.

A thought about notes: if this were done on landscape vs. portrait there would be room for notes at the end of the icons to avoid having another piece of paper that might get lost or dissociated from the address.

Seems that any small block on the form for notes is begging for illegible writing, or overly brief notes. I would envision teams carrying a note pad in addition to these forms. Check the “see notes” box, write the address on the notes, and use as much or little space as needed to make the notes. The extra sheets would get turned in with the damage forms. Yes there is some possibility that the notes would get lost.

Here is the Lamirinda Rapid Needs Assessment form

From Mark
From a "citizen helping citizen" perspective of CERPP, life safety assessment, major hazards and access issues are most important to division leaders. Damage assessment is more of a government need than citizens keeping themselves alive until the professionals restore critical services and functions. I've attached a presentation on how one Bay Area multi-city region, Lamorinda, handles standardized Rapid Needs Assessment forms. Rapid Needs Assesment Presentation

They're a little bigger than us but have a similar multi-jurisdiction fire department and a semi-rural environment.

I prefer the term Rapid Needs Assessment vs Damage assessment as it applies to the role of CERRP because it makes it clear the goal. As a minimally trained division leader, knowing my "rapid needs" is more important than damage.