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LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) CRISIS ASSISTANCE CHECKLIST
This “Checklist” is a guide to help you as you interview applicants for Crisis Assistance. Its purpose is to guide you in asking questions about the household so that you can make a determination about the degree of possible harm and health effects of extreme weather conditions.
1) Are there elderly (age 60 or over) and/or disabled household members? If yes, what is their age and/or disability? How is their age and/or disability affected by extreme weather conditions?
2) Are there household members under 18?
3) Does any household member have a current illness (or history of illness) aggravated by weather? How is the illness aggravated when extreme cold/heat occurs? What medical attention or medical advice has been given which is directly related to extreme cold/heat?
4) Has the household been impacted by a State- or Federally-declared disaster or emergency?
5) Does the household have any electric fans, air conditioner, or other cooling device?
Electric fan Window A/C Central A/C None of the above
If none of the above, how is the house cooled? How have they managed in the past with no cooling? What were the health effects on household members?
6) Are any household members affected by any of the following:
a.
Bedfast or chairfast b.
Partial or complete body cast c.
Circulatory problems, which causes some individuals not to know if they are hot or cold d.
Skin disease, open sores, wounds, shingles e.
Asthma or emphysema f.
Advanced stages of cancer
7) Are any household members currently on medication or under a physician’s care for the treatment of any disorder (such as high blood pressure, asthma, emphysema, etc.) linked to extreme weather?
8) What is the status of household’s heating/cooling supply?
a.
Disconnect Notice
Amount of Outstanding b.
Delinquent Notice
Bill
c.
No Heating/Cooling Supply