Initial Damage & Needs Assessment Survey - Nevis Disaster Management Department (NDMD)

Personal Information

Head of Household

Name of Occupant(required)

Age(required)

ID or Social Security No. (required)

Telephone Number (Home)

Telephone Number (Mobile)

Telephone Number (Work)

Email address(required)

Employment Status(required)

Unemployed

Employed Part-Time

Employed Full-Time

Type of Employment(required)

White Collar

Blue Collar

No. of Persons in Household Employed(required)

Address/Location(required)

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