This document contains forms for hazard and disaster risk assessment, including forms for: 1. Identifying hazards, root causes, early warning signs and existing mitigation measures. 2. Generating scenarios for natural and human-induced hazards, including descriptions of impacts on affected populations. 3. Assessing needs of affected populations, including breakdowns by age and gender. 4. Identifying clusters to coordinate disaster response, assigning lead agencies, and listing member agencies. 5. Inventorying resources, projecting needs, and identifying resource gaps to prepare budgets and funding plans for disaster response.

1. HAZARD PROBABILITY IMPACT AVERAGE
P + I
2
RANK
RATE REMARKS RATE REMARKS
CP Form 1: Hazard Identification

2. ROOT CAUSES EARLY WARNING SIGNS TRIGGERING FACTORS
EXISTING
MITIGATING MEASURES
CP Form 2: Anatomy of the Hazard

3. SITUATIONS BAD WORSE WORST
Description of the Event
CASUALTY
Death
Injury
Missing
AFFECTED POPULATION:
Local
Foreign
EFFECTS ON:
Housing
Properties
Tourism
Agriculture
Fisheries
Livelihood/Business
Roads
Bridges
Communication
Power
CP Form 3A: Scenario Generation for Natural Hazard

4. SITUATIONS
MOST LIKELY
(Normal Activities)
BEST
(with counter-measures)
WORST
Description of the Event (Example:
Movement of the enemy/perpetrators
based on intelligence report)
DESCRIPTION OF THE IMPACT/CONSEQUENCE
CASUALTY
Death
Injury
Missing
AFFECTED POPULATION:
Local
Foreign
EFFECTS ON:
Housing
Properties
Tourism
Agriculture
Fisheries
Livelihood/Business
Roads
Bridges
Communication
Power
CP Form 3B: Scenario Generation for Human - Induced Hazard

5. AFFECTED AREA
(Region/Prov/Mun/Br
gy/Others)
NO. OF
AFFECTED
POPULATION
NO. OF DISPLACED POPULATION ASSUMPTIONS
(why they were
affected/
displaced/
evacuated)
CHARACTERISTICS
INSIDE EVACUATION
OUTSIDE
EVACUATION
TOTAL
Family Persons Family Persons Location Family Persons Family Persons
GONZALES 156 612 156 612 P3-
GYM
0 0 156 612 Seiche
Base surge
fishermen-50%
Farmers-50%
MARIA PAZ 520 2388 0 0 0 520 2388 520 2388 Balistic Projectile
Sieche
Base surge
devastated
AMBULONG 1463 5984 0 0 0 1463 5984 1463 5984 Sieche
Base surge
devastated
WAWA 415 1439 0 0 0 415 1439 415 1439 Sieche
Base surge
devastated
BOOT 1165 5382 1165 5382 1165 5382 Sieche
Base surge
devastated
MAUGAT 200 880 200 800 P2-
CHAPEL
P3-
SCHOOL
0 0 200 880 Sieche
Base surge
Farmers- 80%
BAGBAG 140 300 140 300 P3-
SCHOOL
0 0 140 300 Sieche
Base surge
Farmers-20%
JANOPOL OCC. 80 156 80 156 P4-
COURT
0 0 80 156 Sieche
Base surge
Farmers-10%
BANADERO 200 1011 200 1011 P3-
GYM
SCHOOL
0 0 200 1011 Sieche
Base surge
Fisherman.75%
Farmers-25%
CP Form 4A: Affected Population

6. Location of
Affected
Population
MALE FEMALE
Infant Toddler
Pre-
school
School
Age
Teenag
e
Adult Senior
Citizen
PWDs Others Total
Infant Toddler
Pre-
school
School
Age
Teenag
e
Adult Senior
Citizen
PWDs Pregnant Lactating Others Total
0-12
mos
.
1-3
yo
4-5 6-12 13-17 18-59 60 above
0-12
mos.
1-3 yo 4-5 6-12 13-17 18-59 60 above
TOTAL
CP Form 4B: Breakdown of Affected Population

7. CLUSTER
AGENCIES/OFFICES INVOLVED LEAD
AGENCY/OFFICE
Health / Water/ Wash/
Sanitation
Logistics
Food & Non-food
Items
Law & Order
Emergency
Communication
Management of the
Dead & Missing
Protection Camp
Coordination &
Management
Search/ Rescue/
Retrieval
CP Form 5A: Cluster Identification

8. CLUSTER
LEAD AGENCY/
OFFICE
MEMBER AGENCIES/OFFICES
Health / Water/ Wash/
Sanitation
Logistics
Food & Non-food Items
Law & Order
Emergency
Communication
Management of the Dead &
Missing
Protection Camp
Coordination &
Management
Search/ Rescue/ Retrieval
Emergency Recovery
Education
CP Form 5B: Summary of Cluster Identification

9. NEEDS
ACTIVITIES/
ARRANGEMENTS TO
MEET THE NEEDS
RESPONSIBLE AGENCIES/OFFICES TIMEFRAME
MANPOWER Organization of teams CDRRMO D-3 months
Mobilization and
Deployment
CDRRMO D + 10 days
Equipage CDRRMO D-1 month
CCM EQUIPMENTS Request for purchase of
additional equipment
CDRRMO D- 4 months
Maintenance CDRRMO D- 3 months
Distribution to Evacuees CDRRMO D- 1 month
TENTS Distribution of Tents to
the Evacuees
CDRRMO, GSO D- 1 month
FIRST AID KIT Organization of Team Red Cross, City Health Office W/
Members( Bhw, Bns)
D- 1 month
PILLOWS, MOSQUITO
NET, BLANKET,
FOLDING BEDS
Distribution of Pillows,
Mosquito Net, Blanket,
Bed to the Evacuees
CDRRMO, GSO D- 1 month
PORTALETS Request for General
Services
CITY HEALTH, GSO D-1 month
SAFE WATER Distribution of Safe
Water to the Evacuees
CITY HEALTH D – 10 days
CP Form 6: Needs and Activities Inventory
Cluster: CAMP COORDINATION & MANAGEMENT

10. QUANTITY UNIT RESOURCE AGENCY/OFFICE RESOURCE
LOCATION
REMARKS
100 Unit Tent GSO GSO
50 Packs First Aid Kit City Health City. Provincial
200 Pcs. Pillows “ “
200 Pcs. Blanket “ “
200 Pcs. Mosquito Net “ “
50 Unit CCM
Equipment
CDRRMO CDRRMO
200 Manpower CSWD
50 Unit Portalets GSO/City Health “
CP Form 7: Resource Inventory
Cluster: CCM

11. RESOURCE TARGET POPULATION
STANDARD
S
UNIT
COST
(PHP)
PROJECTED NEEDS CURRENT RESOURCE GAPS
(PROJECTED –
CURRENT)
SOURCE
S TO FILL
THE
GAPS
1 DAY (X) DAYS
FAMILIES PERSONS QTY
COST
(PHP)
QTY COST (PHP) QTY
COST
(PHP)
QTY
COST
(PHP)
Manpower 5,000
45,000
100,00
0
200 100
CDRRMO
TENTS 3,000 5,000 100 50 CDRRMO
FIRST AID KIT 50 25 CDRRMO
PILLOWS 500 250 CDRRMO
BLANKET 500 250 CDRRMO
CCM
EUIP.
50 25
PORTALETS 100 50
MOSQUITO
NET
500
250
CDRRMO
TOTAL
CP Form 8: Needs Projection and Resource Gap Identification
Cluster: CCM

12. Cluster Cost of Projected
Needs
Cost of Current
Resources
Amount of Gaps Source of
Fund
TOTAL (PHP)
CP Form 9: Budget and Resource Summary
Budgetary Summary

13. Cluster Description Projected
Needs
Current
Resources
Gaps Source
Resource Summary