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* 1. Government email address

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* 2. Is this an update to a survey previously at this same site?

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* 3. Current Address (also indicate whether this is a "Home" or "Evacuated" address)

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* 4. Most reliable contact information (email and/or phone)

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* 5. Are your children able to return to their school?

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* 6. Please indicate your childcare situation below

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* 7. Is your primary residence in MFH on Tyndall?

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* 8. Current condition of home residence (consider the condition of your household goods)

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* 9. If your house is uninhabitable, how long do you think it will take to make it habitable? (provide best guess on # of days; consider the condition of your household goods as well)

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* 10. Assuming you have a Government laptop are you able to telework from your current location (Consider availability of laptop and reliable internet connection)?

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* 11. How soon can you reasonably return to work given your current family/home situation? (either telecommute or report to an alternate location in the Panama City area as your situation dictates)

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* 12. Provide additional details not addressed in this survey and/or requests for support (i.e. special needs, family separation issues, etc)

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