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St. Clair County Facility Evaluation Form

Facility Identification
City/Twp: 
Facility Name: 
Address: 
Parcel ID:    Parcel Search  
Phone:      Ext:    
Fax:     TTY: 
E-Mail: 
 
Facility Emergency Contact
Contact 1 Name: 
Phone:  Ext:            
Cell:  Pager: 
Contact 2 Name: 
Phone:  Ext: 
Cell:  Pager: 
Contact 3 Name: 
Phone:  Ext: 
Cell:  Pager: 
 
Facility Description
Heating System  
Is there air conditioning
Generators KW/hr 
If yes,
Power
Entire Building
Lights
Heat
Kitchen
Open Space / Areas
(areas that could be used for additional community sheltering)
Number of rooms
Estimated capacity
Would your facility be willing to shelter outside people? If yes, how many
Shower Number of showers
Restrooms Women Nbr of restrooms
Men Nbr of restrooms
Unisex/Family Nbr of restrooms
Phone Nbr of phone lines
Nbr of pay phones
Fax Nbr of fax machines
Is there internet access
 
Feeding Capabilities
Kitchen Food on Hand:   Days
Would your facility cook
for other locations
Vending Machines
 
Number of Residents
Maximum Capacity
Number of Ambulatory  Non-Ambulatory 
Fire Safety System Automatic Fire Extinguisher
Alarm System
Approx. number of vehicles that can be accommodated in parking lot? Number 

Other
Does your facility have transportation vehicles
If yes, please describe
if yes, what is the capacity of these vehicles?
Additional Comments:

Name of Person who completed survey:
Phone Number:   Ext: 

 

 

 


Contact Information

Office of Homeland Security / Emergency Management
200 Grand River, Suite 204
Port Huron, MI 48060

Phone: (810) 989-6965
Fax: (810) 987-5931
Email: emergencymanagement@stclaircounty.org
 
St. Clair County, Michigan

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