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How to Create a Special Needs Registry

Each community, parish or state or country should have a Special Needs Registry that compiles information on residents with  special needs. The Special Needs Registry is very useful in the event of a disaster. It provides relevant information to jurisdictions about the needs of residents who may require special assistance. This tool, which functions as an organised system of standardized information, can be useful to the users of the information. Users may include the police, fire department, health officials and response agencies. Because of the sensitive nature of the information contained in the registry, it should be kept in strict confidence by trusted leaders.

The registry should be used for those residents who may require assistance during an emergency. Depending on the resources available to the the jurisdiction, the boundaries should be clearly highlighted to the participating residents. Signing up for the registry does not equate to specific assistance during an emergency. This should be communicated to residents in all communities and neighbourhoods. Additionally, because it will be used by a non-governmental body, the registry will not guarantee any service from the government or disaster management agencies.

Benefits of a Special Needs Registry

There are several benefits of creating a special needs registry for your neighbourhood or community. This tool can be used for several types of natural or man-made disasters including hurricanes; storms, both tropical and non-tropical; tornadoes; fires; earthquakes; mudslides and flooding. The registry is the first step in the process of providing assistance to people who are immobile or bedridden; those who require medical equipment; and people with mental and physical disabilities.

How to Create Parameters for Eligibility

It is important that parameters which determine which residents are eligible for inclusion on the registry are created. By doing this, you are ensuring that those who require assistance during a disaster event can receive the help that they need. Priority consideration should be given to residents who are frail and weak; elderly and dependent; medically needy; differently able; and are not assisted by a residential facility program or any other governmental programme.

Additionally, some other factors which can be used are:

  • The use of medical/ life support systems (e.g. oxygen, respirators, ventilators, dialysis machines or pacemakers)
  • Chronic conditions which require special treatment and medication (e.g. diabetics who require insulin or asthmatics who require asthma medications)
  • Mobility issues (e.g. residents who need and use wheelchairs, crutches, scooters, canes, walkers and other mobility devices)
  • Impairments (e.g. differently able residents who are visually impaired, speech impaired, hearing impaired)
  • Disabilities (e.g. speech, cognitive, developmental, mental or behavioural health disabilities)
  • The use of assistive animals and devices (e.g. residents who use service animals and/ or use prostheses)
  • Daily assistance ( e.g. residents who need assistance with  feeding themselves, administering medication and personal hygiene)

The Special Needs Registry Registration Form

To create a registry for your jurisdiction, you will need a form to collect information about the registrants. The Storm Preppers Special Needs Registration Form is a free document that you can use to collect information on residents who require special assistance. To be effective, all fields in the one page form should be completed. To compile the information collected, a master spreadsheet may be used.

Personal Information

The personal information section contains basic information about the registrant. This will enable first responders to easily identify you in an emergency.

  • Last Name: Your first name as stated on your personal identification card
  • First Name: Your last name as stated on your personal identification car)
  • Middle Initial: Your middle initial (s)
  • Sex: Male or Female
  • Date of Birth: The date that you were born using the DD.MM.YY format
  • Age: Your current age

Home Information

Specific details about where you live and your current living situation, can help first responders to assess your surroundings.

  • Address: Your full address including apartment or lot number
  • Living Situation: Whether you live alone, with family or in a group home
  • Type of Residence: State if you live in a private home, condo or apartment

Contact Information

In the event of an emergency, the first responders will use this information to contact you.

  • Home Phone: Your home number at your current residence
  • Mobile Phone: Your mobile phone number
  • Email: An active email address that you use often

Pet/ Service Animal Information

If you have a pet or service animal, please provide details about the animal. Some locations may not have the provisions and facilities to accommodate pets and animals. As a result, they may not be allowed into the facility.

  • Pet/ Service Animal: Indicate if you own either a pet or service animal
  • Type: State the type of pet or service animal. E.g. dog or cat
  • Size/ Weight: State the size and weight of the animal

Emergency Contacts

In the event of an emergency, there should be at least one person who should be contacted so that your situation can be discussed. Please provide the name of a primary contact and a medical contact (e.g. medical doctor).

  • Primary Contact: Provide the name, relationship and contact number
  • Medical Contact: Provide the name, relationship and contact number
  • Other Contact: If desired, provide the contact details for one other contact

Emergency Information

This section details the specific condition(s) that you live with, which is pertinent to the first responders who may be asked to assist you. Please check all of the applicable boxes and underline your specific condition.

  • Impairments: State if you have any speech, hearing, sight or memory loss impairments
  • Requires Life-Sustaining Equipment: State if you require oxygen, a ventilator or dialysis
  • Requires Life-Sustaining Medication: State if you require cardiac, respiratory, diabetes or asthma medication
  • Mobility Impairments: State if you are bedridden or use a wheelchair, walker, scooter or crutches
  • Other: List any other conditions or ailments not listed in this space

There is an acknowledgement and consent statement which states that the registrant has certified that the information is correct. This statement also ensures that the agency/ organisation using the information is not liable for any damages.

The registrant will print his/ her name, then sign and date the form.

The organisation representative will sign in the “Received By” field. Assign a file number and insert the registration date when the registration form has been processed. The final step is that an authorised signatory will sign the form.

Click to download a copy of the Storm Preppers Special Needs Registry Form.

If you have questions, comments, or concerns about creating your registry, please contact us via the Contact page.