Rapid Assessment Field visit local

community
Name of the
village:
Date of visit:
Members team:
(1) Pre-disaster information about the village
Geographical
profle
ocial and
economic
situation
Administrative
structures and
institutions
tructure of population
Age: !"# $"% &!"&# &$"&% '!"$% (!" )otal
Male
Femal
e
)otal
pecial groups
*national+
religious+
linguistic,
(2) Information about the disaster
(3) Afected population and efects of the disaster
Description of
the situation
Number of
a-ected persons
)otal
.asualti
es
/n0ured
1vacuat
ed
2ithout
shelter
.ollectiv
e shelter
3thers
Material
damages
Destroyed
houses
Damaged
houses
4ivelihood
/nfrastructur
e
3thers
(4) Identied needs ! main problems identied
2A5 *2ater+
sanitation+
hygiene,
Nutrition and
food security
helter
Non"food items
5ealth and
psychosocial
needs
3thers
.oping"capacity of the population
(") #esponse $ %hat is happening alread&'
4ocal authorities
.ontact:
.ivil protection+
army+ etc6
.ontact:
.aritas
.ontact:
3ther agencies
.ontact:
.oordination
(() )onditions for program implementation
Access
4ocal support
structures
ecurity
(*) +uggested )aritas #esponse
ignature: Date: