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What is the
Disaster Action Team?
This disaster relief team
provides immediate assistance to victims of disaster. We
ensure the basic human needs of shelter, food, and
clothing are met so that the recovery process can begin.
The most common form of disaster in Huntington County is
the single family house fire, but it could also include
flood, tornado, chemical spill, or any type of natural
or man-made disaster. The team consists of American Red Cross
volunteers and it serves all of Huntington County. And
when there is great need in other parts of the US our
members deploy quickly to help out where needed.
What
do we do?
The American Red Cross
Disaster Action Team (DAT) responds to the scene of a
disaster whenever requested by Police or Fire
departments or the Emergency Management Agency. Our
first priority is the victim(s) of disaster, to ensure
their basic needs are met. The DAT members also provide
canteen assistance to the emergency workers on the
scene. This assistance may include giving food, hot or
cold drinks, and even a recovery shelter if needed. The
Red Cross is committed to taking care of the workers who
serve our community!
The Red Cross
is here to help you prepare for disasters The
American Red
Cross is chartered by the US Congress to provide aid to
those in need, and we will continue to serve that
purpose in Huntington County. However by teaching
disaster preparedness to our community we can help our
friends and neighbors to know how to respond to
emergencies. We cannot always predict when disaster may
strike but we can all take steps to be prepared. This
will minimize the effects of disaster and help to speed
the recovery process.
*For more information about the Disaster Action Team,
disaster preparedness or volunteer opportunities with
the Red Cross, please call the Huntington County
Chapter at (260)-356-2910 or email us at
email@huntingtonredcross.org.
*If you have a disaster
emergency anytime, weekdays or on weekends or
holidays, please call our Disaster Services on-call phone at
(800)-513-2599 ext.636.
Click Here for
recent disaster pictures and information
The Red Cross Health Status
Record
In order to participate in
the Disaster Action Team, a Health Status Record has to
be completed. You will find a copy of the Health
Status Record below. You can download it, and then
email it to the Huntington County Red Cross at the email
above.

Health Status Record
CONFIDENTIAL
To be completed and signed by the
individual. Please print all information
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New |
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Annual Update |
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Change in Health Status |
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If this is an Annual Update,
is there a change in: |
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Health Status |
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Address |
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Phone No. |
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E-mail Address |
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Contact Information |
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Name: |
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DSHR # |
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Last |
First |
MI |
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Address: |
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Street |
City |
State |
ZIP |
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Home |
Cell |
Work |
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E-mail Address: |
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Emergency Contact: |
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Name |
Phone |
Relationship |
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Unit of Affiliation: |
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Chapter Name |
Phone |
Chapter Code |
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Group/Activity/Position: |
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First |
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Second |
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Third |
Mark Yes if you are able and No
if not able and explain any limitations
under "Limitation Explanations" below (all
accommodations must be requested in writing with
supporting medical documentation):
| yes
no |
Lift
and carry 20 lbs multiple times per shift |
yes
no |
Speak clearly on phone and in person |
| yes
no |
Lift
and carry 50 lbs multiple times per shift |
yes
no |
Read
small print for extended periods |
| yes
no |
Stand for two-hour periods |
yes
no |
Work
for long periods on a computer |
| yes
no |
Sit
for two-hour periods |
yes
no |
Climb two or more flights of stairs |
| yes
no |
Walk
on uneven terrain |
yes
no |
Drive in daytime and at night |
| yes
no |
Walk
two miles during a shift |
yes
no |
Work/live in areas with mold/mildew |
| yes
no |
Bend
or stoop multiple times during a shift |
yes
no |
Work/live in areas with smoke/poor air |
| yes
no |
Crawl on floor or ground |
yes
no |
Work/live with little or no privacy |
| yes
no |
Work
outdoors in inclement weather |
yes
no |
Sleep on the floor or a cot |
| yes
no |
Work
in extreme heat and/or humidity |
yes
no |
Travel by any type of transportation |
| yes
no |
Work
in extreme cold |
yes
no |
Work
12 hr shifts/nights/weekends |
| yes
no |
Able
to step up/down 18 inches |
yes
no |
Work
productively during change/stress |
| yes
no |
Spend hours writing |
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Mark Below Yes if
Required or No if Not Required |
| yes
no |
Electricity for medical devices/meds |
yes
no |
Assistance with health monitoring |
| yes
no |
Special food or timing of meals |
yes
no |
Air
conditioning for health reasons |
| yes
no |
Access to specialized medical care |
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Limitation(s) Explanations:
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Date of last Tetanus shot
(Within 10 years is considered up to date):
Date of last Tetanus shot
(Within 10 years is considered up
to date)v
Date of last Tetanus shot
(Within 10 years is considered up
to date)
Date of last Tetanus shot
(Within 10 years is considered up
to date) |
Height :
Weight :
DOB:
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Height: |
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Weight:::
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DOB:
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Allergies (food, medication,
insect, dust, latex, etc.) What happens? What do
you do?
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Explanations:
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In the last 12 months, have you been
diagnosed with/continued treatment for any of the
following?
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yes no |
Heart attack/heart disease |
yes no |
Bleeding
disorders/anticoagulation therapy |
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yes no |
High blood pressure |
yes no |
Stroke/CVA/TIA |
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yes no |
Migraines/frequent headaches |
yes no |
Mental Health (Anxiety/PTSD/Bipolar)
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yes no |
Skin problems/breaks in
skin/lesions |
yes no |
Seizures/nervous
system/neurological |
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yes no |
Stomach/intestine/hernia |
yes no |
Sleep apnea/sleep disorders |
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yes no |
Urinary problems |
yes no |
Problems walking, moving |
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yes no |
Asthma/COPD/emphysema |
yes no |
Back/joint/bone problems |
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yes no |
Vision problems (Not corrected) |
yes no |
Immune system problems |
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yes no |
Hearing problems/hearing aids |
yes no |
Infectious disease |
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yes no |
Diabetes |
Other: |
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Explain ‘yes’ items above:
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Any ER visits,
hospitalizations, surgeries or ongoing therapy
during the last 12 months? yes no |
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If yes, explain and include dates:
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Please list all prescription and over-the-counter
medications, and reason for taking:
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MEDICATIONS |
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HOW OFTEN |
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REASON FOR TAKING |
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List all medical equipment or assistive devices
used (crutches, canes, nebulizer, CPAP, oxygen,
braces (arm/leg), wheelchair, service
animals, etc.): |
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I have reviewed the physical requirements for my
group and activity in Connection 2006-028, Deploying
a Healthy Workforce and the DSHR System Handbook
(with addendums) with my unit of affiliation. I
understand the physical requirements for being a
disaster worker and hereby state that I am able to
fulfill those requirements. I understand that if my
health status changes, I am responsible for updating
this form immediately and submitting to my unit of
affiliation.
I understand that while health insurance is NOT
required, I will be financially responsible for my
health care expenses.
In signing below, I give permission for the Red Cross
Staff Health Reviewer to contact my health care provider
for information concerning my current health status. I
will be notified before contact with my health care
provider is made. I understand that refusal to sign may
limit deployment.
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My typed signature/date is
verification that information on this form is
correct. Please sign form if faxing. |
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Signature of DSHR Member: |
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Date: |
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Signature of Health Reviewer: |
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Date: |
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Codes-Hardship/Restriction: |
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