County Animal Supplies Survey-15

 

1. Company/Organization Name ___________________________________________

Address ______________________________________________________________
                   Number and Street City Zip

Facility Phone (      ) _____-_________ Fax (      ) _____-_________

Representative’s Name _________________________________________________

Representative’s Pager (     ) _____-_________ Cell phone (       ) _____-________

 

2. What supplies do you have?

Veterinary Supplies

‘Drugs ‘Vaccines ‘IV fluids ‘Leg wraps ‘Bandages

 

Non-medical Animal Supplies

Small Animal

‘Pet carriers ‘Cat litter ‘Collars ‘Leashes ‘Cages ‘Shovels ‘Bleach

‘Disinfectant ‘Food and water dishes

 

Large Animal

‘Halters ‘Lead ropes ‘Blankets ‘Bedding ‘Wheelbarrows ‘Rakes

‘Pitchforks ‘Buckets ‘Hoses ‘Fly spray ‘Bleach ‘Disinfectant ‘Lime

 

Office Supplies

‘Trail marking tape ‘Duct tape ‘Microchip scanner ‘Camera/film ‘Paper

‘Pens/pencils ‘Permanent markers ‘Binders ‘Staplers ‘Hole punch

‘Computer/printer ‘Copy machine ‘Flashlights ‘Cellular phones

 

3. Would you be willing to provide these supplies during a disaster?

‘ Free ‘ Loan ‘ Reduced Rate _____________ ‘Standard Rate ___________

 

4. Give brief directions to your location from the closest major road or highway. ________________________________________________________________________

_______________________________________________________________________

_________________________________________________________________________

15-Adapted from the Indiana State Annex for Veterinary Emergencies Committee.

__________________

Draft On- line for
Nevada Animal Disaster Preparedness Guide

The draft was provided by the California Office of Emergency Services.
http://www.cdaf.ca.gov/programs/disasterprep.htm
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