LARGE ANIMAL FACILITIES SURVEY - New Jersey



LARGE ANIMAL FACILITIES SURVEY

Please return to: NJDA, attn: Lynn Mathews, P.O. Box 330, Trenton, NJ 08625

NAME -

ADDRESS -

CITY -

STATE -

ZIP CODE -

COUNTY -

TELEPHONE NUMBER -

(best number to call in the event of an emergency)

EMAIL ADDRESS - _______________________________________________________

1. WOULD YOU BE WILLING TO BOARD LARGE ANIMALS IN AN EMERGENCY? FOR HOW LONG?

HOW MANY AND WHAT TYPE (cows, horses, etc.) ?

DURING WHAT MONTHS WOULD THE ABOVE FACILITIES BE AVAILABLE IN AN EMERGENCY

2. WOULD YOU BE ABLE TO ASSIST IN EVACUATION OF LARGE ANIMALS IN YOUR AREA ?

NUMBER OF TRAILERS AND SIZE -

NUMBER OF VANS AND SIZE -

DISTANCE YOU WOULD BE WILLING TO TRAVEL -

3. DO YOU HAVE MANPOWER THAT COULD ASSIST WITH FEEDING AND CARE OF THESE RELOCATED

ANIMALS?

4. CAN YOU KEEP EVACUATED ANIMALS SEPARATED FROM YOURS? _________________

5. EMERGENCY CONTACTS AND PHONE NUMBERS

A. CONTACT # 1 -

B. CONTACT # 2 -

6. DO YOU HAVE AN EMERGENCY GENERATOR TO PROVIDE POWER?

Response to this questionnaire is voluntary. All personally identifiable information collected by this questionnaire is confidential and will be used to update the emergency preparedness information files that the Animal Emergency Working Group (AEWG) uses in case of evacuation and sheltering needs. Your information will not be used for purposes of taxation, investigation, or regulation. The AEWG will not sell or give this information to mailing or emailing lists.

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