Community Shelter Review Safety Assessment Survey Form
Please complete this survey to help us assess the safety and quality of the community shelter.
How would you rate the overall cleanliness of the shelter?
*
1
2
3
4
5
Is the shelter easily accessible for all community members?
*
Yes
No
Partially
Please rate the adequacy of emergency exits and signage in the shelter.
*
1
2
3
4
5
How would you rate the lighting inside and around the shelter?
*
1
2
3
4
5
Does the shelter have functioning fire safety equipment (alarms, extinguishers)?
*
Yes
No
Not Sure
Please rate the security measures in place (locks, surveillance, staff presence).
*
1
2
3
4
5
Are there any visible hazards (e.g., exposed wires, blocked exits, slippery floors)?
*
None observed
Some minor hazards
Several major hazards
Please evaluate the following aspects of the shelter.
*
Rows
Excellent
Good
Fair
Poor
Restroom facilities
1
2
3
4
Sleeping areas
5
6
7
8
Ventilation
9
10
11
12
Noise levels
13
14
15
16
What is one improvement you would suggest for the shelter's safety?
Overall, how safe do you feel in this shelter?
*
Not Safe
1
2
3
4
Very Safe
5
1 is Not Safe, 5 is Very Safe
Submit Review
Should be Empty: