Assessment Form for Hattiesburg, Mississippi

[GoogleCodeExporter]

Here's the first go at an assessment form for the Hattiesburg, MS Incident. You 
should be able to work from the Hurricane Sandy Assessment Form.  Each one of 
these items will need an English corollary to appear in the info box.
Oh, and I just realized that we're going to need a new Printer Friendly Form. 
I'll work on that next.  I'm thinking that we should take the same approach for 
the Printer Friendly version as we do for the Infobox: Plain English 
descriptions instead of checkboxes.
Note: Use the Flood icon for rain, and I will upload the Tornado icons ASAP.
Let me know if the notes below are unclear.

-------------------------------------
When performing an assessment, consider reading this or a similar script: We 
will add your name to the Hattiesburg Waiting List. This will alert volunteer 
organizations in your area that you need assistance. As the need is so great, 
we cannot guarantee that you will be helped, and we do not know how long you 
might need to wait before an organization helps. We are working as hard as we 
can.

Personal Information
Resident name:*     
Date of Request:    
Street Address:*    
City:*  
County:     
State:*     
Zip Code:   
Latitude:   
Longitude:  
Cross Street or Nearby Landmark:    
Phone Numbers:*     
Best time to call:  
Primary Damage:*    [--Choose One--|Tornado|Rain|Other|Unknown]
Rent/Own/Public     
Work without resident present?  
Member of your organization:    
First Responder:    
Older than 60:  
Disabled:   
Special needs:  
Priority:   
Low (5)                         (1) High

Work

Wind-Related Damage and Needs
Roof Damage:    
Number of 20' x 30'Tarps Needed: 
Debris Removal:
Broken Glass/Window Removal: 
Heavy Item Removal:     
Furniture or Appliance Removal:     
Other Work Requested:   
Notes:  

Tree-Related Damage and Needs
Number of trees down:   
Number of trees wider than 18 inches: 
Other Debris Removal

Rain-Related Damage and Needs
Ceiling Removal:    
Drywall Removal: 
Carpet Removal:     
Hardwood Floor Removal:     
Mold Remediation:   

Hazards
Is the home habitable:  
Power on:   
Downed Wires on Property:   
Other Hazards:  

Claim, Status and Report
Claim for [Org Name]:   
Current Status:     
Volunteers:     
Hours per volunteer:    
Initials of resident present during work:   
Status notes:   

Other Information
Prepared by:    
Do not work before:

Original issue reported on code.google.com by v...@aarontitus.net on 18 Feb 2013 at 2:44

[GoogleCodeExporter]

Omitting:
Tree-Related Damage and Needs
Other Debris Removal

as agreed

Original comment by cpw...@gmail.com on 18 Feb 2013 at 3:53

[GoogleCodeExporter]

Yes. Thank you.

Original comment by v...@aarontitus.net on 18 Feb 2013 at 4:52

[GoogleCodeExporter]

Print Friendly changes for the derecho special case are now on the testbed for 
testing.

Original comment by cpw...@gmail.com on 19 Feb 2013 at 11:11

• Changed state: Started

[GoogleCodeExporter]

Original comment by v...@aarontitus.net on 21 Feb 2013 at 8:28

• Changed state: Fixed