Disaster-Affected Family Support Assessment Form
Family Information
Head of Family Name
Contact Number
Address
Barangay / Community
Family Members
Name
Age
Gender
Relationship to Head
Remarks
Male
Female
Other
Male
Female
Other
Male
Female
Other
Disaster Details
Type of Disaster
Typhoon
Earthquake
Flood
Fire
Volcanic Eruption
Others
Date of Disaster
Description of Impact
Immediate Needs
Food
Water
Shelter
Health/Medical
Other Needs
Assistance Received
Type of Assistance
Source
Date Received
Assessment Remarks