Exercise Dogwood - WSCC Rest Centre and Incident Response Form

Overview

A place for responders on behalf of WSCC and District and Borough Councils to collate data of residents effected by an incident to assist with immediate support and further supplementary support after the incident.

Data privacy

Under the General Data Protection Regulation (GDPR) (EU) 2016/679, WSCC have a legal duty to protect any information we collect from you. Information contained will be used exclusively in direct link to the emergency situation that is taking place, it may be used with partners and agencies who are directly involved in the emergency response.

Data will be used to support those affected by the emergency and once the incident is closed the data will only be used to any ongoing support needs that are identified.

Google Translate - Opens in New Window

Given Name/First Name

Maximum 255 characters

0/255

Family Name/Surname

Maximum 255 characters

0/255

Date of Birth

Address

Maximum 255 characters

0/255

Post Code

Maximum 255 characters

0/255

Contact Number

Maximum 255 characters

0/255

Location/address at time incident occurred?

Maximum 255 characters

0/255

Are you planning on staying at the designated rest centre until the incident has finished?

If you check NO - click save and continue, to take you to the correct next question.

Select option

If you click Yes, please continue with further details. If you click No, please save and continue to submit.

10.

Are there any Urgent Medical Needs or medication required for anybody in your family group?

If URGENT please inform a member of staff immediately!!

Select option

11.

Consequences for not taking medication on time?

12.

What is your first spoken language?

Google Translate

Maximum 255 characters

0/255

13.

Does your faith, religion or any protected characteristic require reasonable adjustments that we need to be made aware of?

If URGENT please notify a member of staff immediately.

Maximum 255 characters

0/255

14.

Number of people currently with you who reside at your address?

Maximum 255 characters

0/255

15.

Their names and age? (If from a different address please fill out a separate form)

Maximum 255 characters

0/255

16.

Do you or anybody in your immediate group consider yourself/themselves vulnerable?

Select option

17.

Photograph of person/persons displaced - if no photo on phone please take one of yourself (or group) for identification purposes if you can.