Organizing Your Neighborhood for Y2K

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Special Needs:

Need / Yes / No / Name of Person

Medicine

Type:
Quantity:

Type:
Quantity

Type:
Quantity:

Oxygen
Wheel-chair bound
Chemical Sensitivities
Illness:
- Alzheimers
- Heart Disease
- Mental Illness
- Down syndrome
Physically handicapped
Visually handicapped
Hearing Impaired
Other needs: (e.g., special formula)

SKILLS INVENTORY

No. / Skill / Name of Person, Address

Construction
- Carpenter
- Plumber
- Electrician
- Welder

Dentist

Medical Doctor (type)
- Pediatrician
- Surgeon

Nurse

Natural Doctor

Other Medical
- Chiropractor
- EMT

Midwife

Veterinarian

Childcare

Teacher

Car Mechanic

Police Officer

Fireman

Other
(e.g., musician, cook,
storyteller, etc.)

Neighborhood Survey

(To be filled in and used by Neighborhood Coordinator(s))

Coordinator's Name:__________________ Phone No.:________

Coordinator's Name:__________________ Phone No.:________

Address covered by neighborhood:________________________

Draw a picture of your neighborhood. For example, one block (both sides of the street?); cul-de-sac; building, etc. Include squares for each house, mobile home, apartment, with address.
 
 
 
 
 
 
 
 
 
 

Mark each home as follows:
Last name of family and address
B--basement (not in flood zone)
G--gardening space (size)
E--electricity (stove, heaters, water heaters)
S--sewage (septic, other)
Y--yard space (size)
NG--natural gas (stove, heaters, fireplace, water heaters)
W--water (well, tap)

List Skills for Entire Neighborhood

No. / Skill / Name of Family Member

Construction
- Carpenter
- Plumber
- Electrician
- Welder

Dentist

Medical Doctor (type)
- Pediatrician
- Surgeon

Nurse

Natural Doctor

Other Medical 
- Chiropractor
- EMT

Midwife

Veterinarian

Childcare

Teacher

Car Mechanic

Police Officer

Fireman

Other

PHYSICAL INVENTORY 
for each home in neighborhood

Address:______________________________

Physical inventory complete? / Yes / No

Basement (not in a flood zone)
Yard
Vegetable garden space (approx. size______)

Natural Gas:
- Heater
- Water heater
- Fireplace
- Stove
Electric:
- Heater
- Water heater
- Fireplace
- Stove

Water:
- City Fed
- Well
- Other: (explain)
Sewage:
- Septic
- City
- Other: (explain)

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