Att B-4 - CPS Weather Event Items (as needed)

Attachment B-4

Basic CPS Weather Event Items

(added on an “as needed” basis)

HHSCREEN

Did (you/anyone in this household) evacuate, even temporarily, where he or she was living since last month because of (name of weather event)?

1. Yes

2. No

DSTR_ROSTER

Earlier you indicated that at least one person in the household had to evacuate, even temporarily, where he or she was living in (month/year) because of (name of weather event). Who is that?

Enter line number(s)

DSTR2

In (month/year), prior to the (type of disaster) warning, where (were you/was NAME) living?

1. At this current address

2. A nearby state

3 Elsewhere in the United States

DSTR3

What county, parish, or city (were you/was NAME) living in prior to the (type of disaster) warning?

1. Yes

2. No

3. Proxy

DSTR4A/DSTR4B

When did (you/NAME) return?

Enter month and day

DSTR5

Did (you/NAME) move back, even temporarily, to the address (you/he/she) had prior to (name of weather event)?

1. Yes

2. No

DSTR6

How long did (you/NAME) stay?

1. Less than 2 weeks

2. 2 to 4 weeks

3. A month or more

DSTR7

Why did (you/NAME) leave after returning?

Specify reason for returning