OEMC Community Essential Information Survey

Community Name *

Mayor/Village President *

First

Last

Name of Person Completing Survey

First

Last

City/Village Hall Address *

Address Line 1

Address Line 2

City

State

Zip Code

Main Office / Business Phone *

24/7 Emergency Contact Number *

Mayor Cell Phone *

Mayor's Cell Phone Provider *

Mayor's Direct E-Mail *

City/Village Hall Main E-Mail *

Financial / Billing Contact *

Financial / Billing Contact E-Mail *

City Demographics

Below you find a survey concerning your departments. Please include all emergency contacts you have available and as much information as possible. These numbers will not be released and used by the OEMC to contact your officials after hours. Please use the format: Order of Contact / Name / Cell Phone / Phone Provider / E-Mail. Please include a mailing address for the Department as well.

City Council

Order / Name / Cell Phone / Carrier / E-Mail

Water Department *

Order / Name / Cell Phone / Carrier / E-Mail

Sewer Department *

Order / Name / Cell Phone / Carrier / E-Mail

Street Department *

Order / Name / Cell Phone / Carrier / E-Mail

Code Enforcement / Zoning *

Order / Name / Cell Phone / Carrier / E-Mail N/A if not applicable.

Other Department (Identify Below)

Order / Name / Cell Phone / Carrier / E-Mail N/A if not applicable.

Special Resources / Response Capabilities *

Please list each special resource your city maintains that could be useful in a disaster. This does not include day to day emergency services. N/A if not applicable.

Additional Resources / Information *

Use this section to list any other special resource, capability, or information that you would like to include. N/A if not applicable.