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Emergency Preparedness Temporary Shelter: “Like Facility” Roster (2026)

Members interested in participating should complete the survey by Friday, May 29, 2026

LeadingAge Wisconsin is updating the Emergency Preparedness "Like Facility" Roster last published in 2025.

Complete one survey for each type of facility.
Please direct questions about this project to Marissa Janke (mjanke@leadingagewi.org) or 608-398-8093.
1.Name of Facility(Required.)
2.Type of Facility(Required.)
3.Number of beds/units?(Required.)
4.Facility Mailing Address(Required.)
5.City(Required.)
6.State(Required.)
7.Zip Code(Required.)
8.County(Required.)
9.First Name of Primary Contact Person(Required.)
10.Last Name of Primary Contact Person(Required.)
11.Title of Primary Contact (Required.)
12.Email Address of Primary Contact(Required.)
13.Primary contact's daytime (Monday - Friday) telephone number including area code(Required.)
14.Primary contact's after hours (evening, weekend, holiday) telephone number including area code(Required.)
15.Alternate facility telephone number that can be called 24/7/365 to get in touch with primary contact or designee(Required.)