Disaster Assessment Form

The Kentucky LTC Facility Disaster Assessment Form can be used to assess your facility status after a disaster.  If your facility is involved in disaster situation use this form to report that your facility status is OK or to report that assistance is needed.

Once completed, scan and email to:
Betty Shiels – Betty.Shiels@louisville.edu or Diana Jester – Diana.Jester@louisville.edu

Disaster Assessment Form