ML20203P907
| ML20203P907 | |
| Person / Time | |
|---|---|
| Site: | Limerick  |
| Issue date: | 11/28/1984 |
| From: | AFFILIATION NOT ASSIGNED |
| To: | AFFILIATION NOT ASSIGNED |
| References | |
| OL-I-LEA-E-044, OL-I-LEA-E-44, NUDOCS 8605080319 | |
| Download: ML20203P907 (1) | |
Text
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August 1.1983 Dear Residenc
%, j, 3 0 Your local emergency services are gathering information to serveyou better. We are particularly concerned about those residents who may require special assistance or may have transportation prob! ems. To help us. please complete this form foryour household. lfyou checked any of the boxes please return both copies in the enclosed envelope. No stamp is necessary.
I. Does everyone in your household usually have private transportation available?
O No
- 2. Do you have a telephone?
O No
- 3. Does everyone in your household understand English?
O No What language is spoken?
- 4. Does anyone in your household have any of the following problems:
O Hearing impairment O sight impairment O Speech Impairment O Non-ambulatory if either of the above is
[must use wheelchair, confined to bed, etc.)
checked, is a teletypewriter O other available O No O Yes Please Explain If anyone in your household had to be refocated, would any type of special assistance be required?
A O Personalassistance D.
O Ambulance B.
O Special Vehicle E. O otner C.
O Medical Equipment P! ease Explain if you did not check any of the boxes. there is no need to complete or return'this form.
PLEASE PRINT Name Telephone Address PA ppl Township / Boro County Name of Person Completing Form If you have completed this information form, please return in the postage paid enve' ope.
This information is considered confidential and will be used for emergency planning purposes only. You may be contacted by emergency services personnel in order that it may be verified and periodically updated.
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