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RAPID NEEDS ASSESSMENT FORM

Province:                                                                           Main Event:
Assessment/Report Date:                                                             Date and Time of Event:
Participating Organizations: Plan Philippines                                       GPS Coordinates of area being assessed:
Affected Municipalities/Cities:                                                     Area assessed:


I.       General Situation Before Disaster
     Total Population          % Women                        % Men                    Ave No. of        No. of handicapped         Poverty Rate
                                                                                     persons/family           or PWDs




II.      General Situation After Disaster
      Affected Barangays         Persons/         Persons        Deaths      Injured       Missing       Children        Pregnant          Seniors
                                 families        /families                                               under 5         Women              (>70)
                                 affected        displaced




III.    Characteristics of Disaster Zone
       Urban proportion (est %)              Rural Proportion (est %)        Economic Activity (agricultural,          Ethnic Groups (cultural,
                                                                             commercial, industrial, others)                 languages)


Observations:
    •

IV.  Accessibility to Affected Municipalities and Disaster Zones
                                    By Land/est travel time/vehicle         By Air/est travel time/flights        By Water/est travel time/vessel
                                    type                                    available                             type
To the municipal/city center

Routes to affected zones

Observations/Recommendations:

              •

V.    Electricity, communication and Fuel in Disaster Zones
                               Operational/Normal                    Intermittent               Non-operational                     Why?
Electricity
Telephone/fax
Mobile phone
Radio
Television
Radio Communication
Fuel Distribution
Observations/Recommendations:


VI.      Health
                                  Availability of Medical Personnel, Medicines and Medical Supplies and Others
                                Available Provisions (Y/N)            With Extra Provisions (Y/N)              Satisfy the Needs (Y/N)
Medical Personnel
Medicines
Medical Supplies
Others
                                                      Health Establishments in the Disaster Zone
  Name of               Category           Operational          Non-            Type of          No. Beds           Water (Y/N)        Electricity
Health Facility                               (%)           operational         Damage           Available                           (Y/N)/Back-up
Power (Y/N)
RHU
Oras
Municipal
Hospital




                                                              Disposal of Corpses
                                                                                                  Yes                           No
Are there any problems for disposal of human corpses?
Are there any problems for disposal of animal corpses?
Impact on Health: High ; Medium; Low; None -
Early Recovery Issues:
Observations/Recommendations:


VII. WASH
                                          Yes                   No                                      Observation
Was there water supply before
the event?
                                     Sufficient (%)           Poor (%)          None (%)                       Observations
Estimated dwellings/ shelters
with water (%)
                                     Surface (Y/N)          Subterranean                                Observations
                                                                (Y/N)
Alternative sources of water
supply
Water source                                Status before the disaster              Damaged         Contaminated              Destroyed
                                                 (working or not)
Wells
Rivers/streams
Storage infrastructure
Aqueduct
Spring
Others
Impact on Water Supply: High ; Medium; Low; None :
Sanitation System                                   Functional                  No. of Units Damaged                  Observations
                                                Yes         No                                                 (signs of contamination?)
Latrines
Sewer System
Septic Tanks

Waste disposal system                                       Functional                                  Observations
                                                      Yes           No                           (signs of contamination?)
Solid waste
Discharge of grey/black liquids
Rubbish disposal
                                                         Main Sanitation Needs
             Needs                        Estimated Quantity             Estimated No. of Families                     Observations




Impact on Sanitation: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:


VIII. Food and Nutrition
                                                                 Food Sources
   Main source of food for displaced families            Before the disaster            After the disaster               Observations
               Self-production
                   Purchase
             Donations/food aid
               Exchange/Trade
                   Collection
                                                Means for affected families to prepare food
Yes           No                          Observations
                           Water
                          Kitchen
                 Fuel/firewood for cooking
                      Kitchen Utensils
                                                                 Food Reserves
                                                                   Yes         No                            Observations
            Do the affected families have food?
            Do the displaced families have food?
          How long would the reserves last, if any?
     Do the affected/displaced families have capacity to
                      access/buy food?
                                                               Food Interventions
     Food distribution              Organization              Products distributed       Available inventory           Existing program?
                                                                                                                       Yes            No




                                                       Main Needs in Food and Nutrition
                  Assessed Needs                       Estimated Quantity     Estimated No. of                    Observations
                                                                                  Families




Impact on Food and Nutrition: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:


IX. Shelter
Estimated No. of destroyed shelters:
Estimated No. of damaged shelters:
Estimated No. of families in evacuation centers w/ destroyed shelters:
Estimated No. of families staying with host families:
                                                          Main Needs in Shelters
                               Needs                                       Estimated Quantity             Estimated No. of Families




Impact on Shelter: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:


X.     LIVELIHOOD
                                                         Impact on Livelihood Sectors
          Activity/Sector                           Impact                   Sectors Mainly Female or Male        Estimated No. of Families
                                      High         Medium        Low                                                      Affected
             Farming
          Cattle Raising
              Fishing
            Industrial
           Commerce
          Manual Labor
          Skilled Labor
              Others
                                                          Main Needs in Livelihood
              Needs                          Estimated Quantity           Estimated No. of Families to                Observations
                                                                                    Benefit
Impact on Livelihood: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:


XI.   Protection
                                                               Situation of Children
                                   Total Number                        Boys                              Girls                    Identification/
                                                                                                                                  Documentation
Orphans
Separated from Parents
                                                                          Yes          No                               Observations
Have there been instances, registration or monitoring of
mistreatment, rape and sexual abuse?
Are there organizations that work in psychosocial support?
Are there organizations that work for the protection of rights?
                                                                                                             Barriers
Main barriers for the fulfilment of basic protection principles and
actions
                                                            Main Needs in Protection
             Needs                                Quantity                        No. of Families                               Observations




Impact on Protection: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:


XII. Education
                                                                Impact on Schools
                                              Total Existing                     Total Damaged/ %                            Total Destroyed / %
No. of Classrooms
Furnishings Affected (est %)
Materials Affected (est %)
No of Students Affected              All
                                                           Main Needs in Education
               Needs                            Quantity                        No. of Families                                 Observations




Impact on Education: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:



XIII.        Organization and Coordination –
   Orgzn          Health        WASH         Shelter       Protection        Food           Livelihood           Education      Security       Others
Provincial
Clusters
PDCC
CDCC
MDCC
BDCC
Others
                                              Information Flow (Check if existing and X if not)
                        NGOs          UN Agencies        BDCC               MDCC                CDCC                    Provincial          PDCC
                                                                                                                         Clusters
NGOs                      x
UN Agencies
BDCC                                               x
MDCC                                                   x
CDCC
Provincial
Clusters
PDCC                                                       x

Main Needs in Coordination:



Impact on Coordination: High ; Medium; Low; None
Early Recovery Issues:
Observations/Recommendations:

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Step 1. Rapid Needs Assessment Form

  • 1. RAPID NEEDS ASSESSMENT FORM Province: Main Event: Assessment/Report Date: Date and Time of Event: Participating Organizations: Plan Philippines GPS Coordinates of area being assessed: Affected Municipalities/Cities: Area assessed: I. General Situation Before Disaster Total Population % Women % Men Ave No. of No. of handicapped Poverty Rate persons/family or PWDs II. General Situation After Disaster Affected Barangays Persons/ Persons Deaths Injured Missing Children Pregnant Seniors families /families under 5 Women (>70) affected displaced III. Characteristics of Disaster Zone Urban proportion (est %) Rural Proportion (est %) Economic Activity (agricultural, Ethnic Groups (cultural, commercial, industrial, others) languages) Observations: • IV. Accessibility to Affected Municipalities and Disaster Zones By Land/est travel time/vehicle By Air/est travel time/flights By Water/est travel time/vessel type available type To the municipal/city center Routes to affected zones Observations/Recommendations: • V. Electricity, communication and Fuel in Disaster Zones Operational/Normal Intermittent Non-operational Why? Electricity Telephone/fax Mobile phone Radio Television Radio Communication Fuel Distribution Observations/Recommendations: VI. Health Availability of Medical Personnel, Medicines and Medical Supplies and Others Available Provisions (Y/N) With Extra Provisions (Y/N) Satisfy the Needs (Y/N) Medical Personnel Medicines Medical Supplies Others Health Establishments in the Disaster Zone Name of Category Operational Non- Type of No. Beds Water (Y/N) Electricity Health Facility (%) operational Damage Available (Y/N)/Back-up
  • 2. Power (Y/N) RHU Oras Municipal Hospital Disposal of Corpses Yes No Are there any problems for disposal of human corpses? Are there any problems for disposal of animal corpses? Impact on Health: High ; Medium; Low; None - Early Recovery Issues: Observations/Recommendations: VII. WASH Yes No Observation Was there water supply before the event? Sufficient (%) Poor (%) None (%) Observations Estimated dwellings/ shelters with water (%) Surface (Y/N) Subterranean Observations (Y/N) Alternative sources of water supply Water source Status before the disaster Damaged Contaminated Destroyed (working or not) Wells Rivers/streams Storage infrastructure Aqueduct Spring Others Impact on Water Supply: High ; Medium; Low; None : Sanitation System Functional No. of Units Damaged Observations Yes No (signs of contamination?) Latrines Sewer System Septic Tanks Waste disposal system Functional Observations Yes No (signs of contamination?) Solid waste Discharge of grey/black liquids Rubbish disposal Main Sanitation Needs Needs Estimated Quantity Estimated No. of Families Observations Impact on Sanitation: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: VIII. Food and Nutrition Food Sources Main source of food for displaced families Before the disaster After the disaster Observations Self-production Purchase Donations/food aid Exchange/Trade Collection Means for affected families to prepare food
  • 3. Yes No Observations Water Kitchen Fuel/firewood for cooking Kitchen Utensils Food Reserves Yes No Observations Do the affected families have food? Do the displaced families have food? How long would the reserves last, if any? Do the affected/displaced families have capacity to access/buy food? Food Interventions Food distribution Organization Products distributed Available inventory Existing program? Yes No Main Needs in Food and Nutrition Assessed Needs Estimated Quantity Estimated No. of Observations Families Impact on Food and Nutrition: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: IX. Shelter Estimated No. of destroyed shelters: Estimated No. of damaged shelters: Estimated No. of families in evacuation centers w/ destroyed shelters: Estimated No. of families staying with host families: Main Needs in Shelters Needs Estimated Quantity Estimated No. of Families Impact on Shelter: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: X. LIVELIHOOD Impact on Livelihood Sectors Activity/Sector Impact Sectors Mainly Female or Male Estimated No. of Families High Medium Low Affected Farming Cattle Raising Fishing Industrial Commerce Manual Labor Skilled Labor Others Main Needs in Livelihood Needs Estimated Quantity Estimated No. of Families to Observations Benefit
  • 4. Impact on Livelihood: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: XI. Protection Situation of Children Total Number Boys Girls Identification/ Documentation Orphans Separated from Parents Yes No Observations Have there been instances, registration or monitoring of mistreatment, rape and sexual abuse? Are there organizations that work in psychosocial support? Are there organizations that work for the protection of rights? Barriers Main barriers for the fulfilment of basic protection principles and actions Main Needs in Protection Needs Quantity No. of Families Observations Impact on Protection: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: XII. Education Impact on Schools Total Existing Total Damaged/ % Total Destroyed / % No. of Classrooms Furnishings Affected (est %) Materials Affected (est %) No of Students Affected All Main Needs in Education Needs Quantity No. of Families Observations Impact on Education: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: XIII. Organization and Coordination – Orgzn Health WASH Shelter Protection Food Livelihood Education Security Others Provincial Clusters PDCC CDCC MDCC BDCC Others Information Flow (Check if existing and X if not) NGOs UN Agencies BDCC MDCC CDCC Provincial PDCC Clusters NGOs x UN Agencies
  • 5. BDCC x MDCC x CDCC Provincial Clusters PDCC x Main Needs in Coordination: Impact on Coordination: High ; Medium; Low; None Early Recovery Issues: Observations/Recommendations: