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BOROUGH OF WESTWOOD OFFICE OF EMERGENCY MANAGEMENT (Borough of Westwood)

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BROWSE BOROUGH OF WESTWOOD (NJ) FORMS

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BOROUGH OF WESTWOOD
OFFICE OF EMERGENCY MANAGEMENT
TELEPHONE (201) 664-7100 Ext. 123 101 WASHINGTON AVE WESTWOOD, NJ 07675
In an effort to expedite the notification process of residents affected by flooding conditions
within the Borough of Westwood, the Office of Emergency Management is requesting that
you complete the following voluntary questionnaire.
Name:__________________________________________________________________________
Address:________________________________________________________________________
Number of Persons in Household: __________
Number of Special Needs Persons (elderly/disabled/non-ambulatory/etc.): ____________
________________________________________________________________________________
Number/Type of Pet(s): __________________________________________________________
Telephone Numbers:
Home: _____________________ Work: _____________________ Cell: ____________________
Additional (relative/friend/alternate): _____________________________________________
E-mail Address: _________________________________________________________________
Location of Furnace/Water Heater: ________________________________________________
Type of Fuel: Gas ________ Electric ________ Fuel Oil ________ LPG ________
Location of Electric Panel: ________________________________________________________
Darren Blankenbush
OEM Coordinator
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BOROUGH OF WESTWOOD OFFICE OF EMERGENCY MANAGEMENT (Borough of Westwood)

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Completed 17 July 2020

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