Assisted Evacuation Centers Survey

Assisted Evacuation Centers

1. San Diego County Office of Emergency Services - Assisted Evacuation Centers Survey

This survey is to be completed by Adult Day Health Centers and City-Operated Senior facilities, as well as select non-profit organizations considered for use as an assisted evacuation center.

If you have questions on this survey, please e-mail Michael.Walter@sdcounty.ca.gov or call (858) 715-2275

1. Which facility do you represent?

	Select from below
Please select	Which facility do you represent? Please select Select from below

If not listed, please specify:

2. Please provide us with a contact name, email address and phone number for your organization.

Please provide us with a contact name, email address and phone number for your organization.

3. Does your facility have a kitchen?

Does your facility have a kitchen? Yes

Other (please specify)

4. Is your facility ADA Accessible?

Is your facility ADA Accessible? Yes

5. How many of the following do you have? (if none, please enter 0)

	Men	Women	Unisex
Toilet Stalls	How many of the following do you have? (if none, please enter 0) Toilet Stalls Men	Women	Unisex
Showers	Showers Men	Women	Unisex

Other (please specify)

6. Does your facility have an area of covered open space (auditorium, gymnasium, multipurpose room)?

Does your facility have an area of covered open space (auditorium, gymnasium, multipurpose room)? Yes

If so, what is the approximate square footage?

7. Is this facility operated out of a private home?

Is this facility operated out of a private home? Yes

Other (please specify)

8. Does this facility have, or is it located adjacent to athletic fields or a large parking lot?

Does this facility have, or is it located adjacent to athletic fields or a large parking lot? On-Site fields

Adjacent fields

No athletic fields

Other (please specify)

9. Does this facility operate with any durable medical equipment? (Wheelchairs, Hoyer Lifts, Walkers?)

Does this facility operate with any durable medical equipment? (Wheelchairs, Hoyer Lifts, Walkers?) Yes

If so, please specify

10. Please tell us anything else you think we should know about your facility

Please tell us anything else you think we should know about your facility

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