Title Page
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Document No.
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Is this a Damage Assessment or a Welfare Check ?
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Residents Name
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Address
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Location
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Conducted on
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Prepared by
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Additional people conducting the DA/Check ?
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If this job was referred from another agency, please list.
Person details - The Story
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How many Residents at this address ?
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Do the Residents Own or Rent the property ? Select N/A if they do not fit this.
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Are the residents insured ?
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What is the approximate age of the resident/s ?
- <40
- 40-60
- 60-80
- 80<
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One or more of the residents are suffering from a medical condition ? (This includes mental and physical)
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Please list any details.
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Has the resident been displaced from their home ?
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List any details as to where they are currently staying ?
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Does the property have power ?
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Does the property have running water ?
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The resident require drinking water ?
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Please list amount required and type (e.g.. drink bottles/10L containers)
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The resident requires food ?
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Please list amount and type and any dietary requirements.
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Are there any animals on the property that a team should be aware of ?
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Please list details.
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You are the first member of an Organisation (Govt or NGO) that they have seen.
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Did the resident know who TR was, and if so at what level ?
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Has the resident been a member of a defence force or first responder agency, or currently is ?
- No
- Navy
- Army
- Airforce
- Ambulance
- Fire
- Police
- Other
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Please list any additional information that TRA should be made aware of.
Damage Assessment
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What work does this job require ?
- Green Waste removal
- Cross Cut Only
- Cross Cut and remove
- Deconstruction
- Mechanical Waste Removal
- Interior Goods removal
- Interior floor coverings removal
- Interior wall covering removal
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Provide photos of tasks required.
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Provide more detail if required.
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Are any structures currently unsafe ?
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Add photos of structural concerns ?
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Provide more detail if required.
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Are any access's currently obstructed ?
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Add photos of areas.
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Provide more detail if required.
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Is the property habitable ?
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Add photos of concerns.
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Provide more detail if required.
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Are any electrical hazards present ?
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Add photos of concerns.
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Provide more detail if required.
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Is there any Asbestos containing material present ?
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Add photos of concerns.
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Provide more detail if required.
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Are there any slip, trip, fall, or head impact hazards present ?
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Add photos of concerns.
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Provide more detail if required.
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Does this job require green waste or mechanical waste removal ?
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Is council or other pickup available ?
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If pickup is unavailable, where and how far away is the nearest dump ?
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How long do you estimate these tasks taking ?
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What are the priority areas to the resident ?
Welfare Check
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Do you think the Resident would self harm ?
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Provide a description of your memory of the discussion and situation with this person/s.
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Provide a description of the persons property and living state.
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Do you think further checks are required on this resident ?
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Provide further information if relevant.
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Can TRA do anything to improve this persons situation ?
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Provide further information if relevant.
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Should this Resident be referred to another organisation ?
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Provide details of type of assistance required.
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How do you personally feel about the experience ?
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Please provide details if you wish.
Additional Information and Assessment
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How do you rate the priority of this job ?
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Should this job referred to others ?
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Provide organisations or list of needs.
