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2. Municipality Name(s):
4. Name of Person Completing Worksheet:
6. Email of Person Completing Worksheet:
8. Hazard Addressed
   -- Select One --Civil DisturbanceDam FailureDroughtEarthquakeExtreme TemperaturesFlood/Flash Flood/Ice JamHailstormHazardous MaterialsHurricane/Tropical Storm/Nor'easterInvasive SpeciesLandslideLevee FailureMass Food and Animal Feed ContaminationNuclear/RadiologicalPandemic/Infectious DiseaseRadon ExposureSubsidence/SinkholeSubstance Use DisorderTerrorismTornadoTransportation IncidentsUrban Fire and ExplosionWindstormWildfireWinter Storm
10. Problem Description

    Please explain the impact of the selected hazard specifically related to people and property . Please include an address or approximate location (near a particular intersection, upstream from a certain crossing, wooded area on west side of XXX Road, etc.)

12. Action/Project Description

    Please describe the action/project that could address or mitigate the hazard identified above.

14. Benefits

    Who benefits from this action or project?  In what way(s)?

16. Other Things to Consider

    Are there other issues to consider when discussing this action/project?

18. Thank you for your interest in hazard mitigation action/project identification.  Your input on this worksheet will inform this planning initiative insuring there are actions/projects for each hazard and within each municipality.

20. To follow the progress of this planning initiative, go to www.yorkhazmit.org. 

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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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