American Red Cross

Initial Intake and Assessment Tool


The main purpose of the Initial Intake and Assessment Tool is to enable ARC staff to decide if simple accommodations can be provided that will enable individuals to stay in general population shelters. The secondary purpose is to ensure proper and safe placement of these clients with medical or functional needs beyond the scope and expertise of care offered in ARC shelters. The ARC and its partner, HHS, are determined to maximize the use of this tool to minimize stress and emphasize the safety and well-being of those served during times of disaster.


Top Section of the Tool

Shelter workers meet with clients and legibly record pertinent information in the top portion of the tool and questions 1 through 9. The remaining questions are only to be completed by Disaster Health Services (HS) and Disaster Mental Health (DMH) workers. Only one form is used for each family. Questions in the first part of the tool are designed to identify language barriers, separated families, and other important information to be passed on to the shelter manager. The top section of the tool asks for basic demographic information in addition to:

  • The Disaster Relief Operation (DRO) (enter name and number of the DRO)
  • The names of the family members in the shelter
  • The shelter worker’s initials to indicate that he/she has notified the shelter manager when a person younger than 18 is unaccompanied in the shelter

Once a client has been referred to HS/DMH, all information is confidential and will only be seen by licensed healthcare providers. Initiate a Client Health Record (F2077) for the client, and attach the tool. In situations in which a client has physical and psychological concerns, he/she should be seen by both a DMH and an HS worker.