West Tisbury Community Emergency Response Survey
Dear Neighbor,
The Climate Advisory Committee is working hard to prepare the Town and its residents for extreme weather events, fire and prolonged power failures.  The Committee, Fire and Police Chiefs, and the Emergency Manager, would appreciate your answering the following questions so that we know what services you might need or can provide during emergencies.  For more information on Storm and Fire Preparedness, go to westtisbury-ma.gov/climate-advisory-committee/pages/forms-documents.
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Name(s), and age of each member of your household *
Home Address: *
Primary household email address
Primary household cellphone number
Primary household landline number
Do you have pets?
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Are you a year-round resident?  
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If you are not a year round resident, please indicate which months of the year you are here
If you are not a year round resident, is this home occupied by others when you are not here?
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If this home is occupied by others, please provide their contact information.
Are you part of a road association?
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If you are part of a road association, who is the contact person?
Have you registered for CodeRED (Town emergency notification system)? If not, please register:   go to the Action Center at westtisbury-ma.gov 
Do any of your household members have special medical needs? If so, please check the appropriate boxes below.
When a major event has occurred, would you like to be contacted for a wellness check?
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Do any household members have specialized skills you would be willing to share in case of emergency such as:
Do you have equipment such as a bobcat, chainsaw or snowplow that you would be willing to use in times emergency in order to assist your neighbors?
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If so, what would you be willing to do to help?
Do you own a generator?  
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Is there a hand water pump on your property?
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Would you be willing to be part of a Community Emergency Response Team for the Town and attend the trainings?
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Is there anything else we should know about your needs or ability to help during emergency events?
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