PDF《关于这次灾害之后您的房屋和财产受损的情》

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关于这次灾害之后您的房屋和财产受损的情 况,我想问您几个问题. Simplified Chinese Hello. There are some questions I need to ask you about damage to your home and property after the disaster. 我们在这里写出了问题.我们还给出了大多数问题 的可选答案.请您指出或写出答案,以便我们了解 您需要什么帮助.如果您对问题不明白,或者不知 道怎样回答,请指向问题表上的"不确定". Simplified Chinese I have each question written for you. We will give you answer choices for most questions. Please point to the answer or write an answer so we can find out what help you might need. If you are not sure about a question or how to answer the question, please point to "Not sure" on the sheet. 您遇到了哪一类灾害? ? 火灾 ? 煤气泄漏 ? 停电 ? 化学品溢出 ? 风暴或龙卷风 ? 生物灾害 ? 爆炸或炸弹袭击 ? 以上清单没有列 出的其他灾害 ? 水灾 ? 不确定 Simplified Chinese What type of disaster were you involved in? ? ??Fire ??Gas leak ? ??Power outage ??Chemical spill ? ??Storm or tornado ??Biological disaster ? ??Explosion or bombing ??Other not on this list ? ??Flood ??Not sure 您是一个人来我们机构的吗? 否 不确定 是Simplified Chinese Did you come here alone? No Not sure Yes 是否有亲友与您一起来? 否 不确定 是Simplified Chinese Do you have other family member or friends with you? No Not sure Yes 如果有,能否说出或写下他们的姓名和年龄? 否 不确定 是Simplified Chinese If yes, can you tell me or write their names and ages? No Not sure Yes 您现在住在哪里? ? 自己家 ? 邻居家或朋友家 ? 避难所 ? 旅店 ? 不确定 Simplified Chinese Where are you staying now? ? At our home ? With a neighbor or friend ? Shelter ? Hotel ? Not sure 您是否有身份证明资料显示受灾住址? 否 不确定 是 如果是 C 请让我看一看. Simplified Chinese Do you have a piece of identification with the disaster address on it? No Not sure Yes If yes, please show me. 您住在什么样的建筑物内? 独立房屋 共有公寓 公寓 活动房屋 其它 不确定 Simplified Chinese What kind of building do you live in? House Condominium Apartment Mobile home Other Not sure 请介绍您的房屋的情况. 只有一层 有两层 有三层或更多层 有地下室 Simplified Chinese Tell me about your house. All rooms are on

1 floor or

1 level There are rooms on

2 levels There are rooms on

3 or more levels There is a basement 地址 请说出地址,或者给我看包含地址的材料,或 者把地址写在纸上. ? 不确定 Simplified Chinese Address Please tell me or show me something with the address, or write the address on paper. ? Not sure 有多少人住在您的住宅中? ? 请说出人数,或者写在纸上. ? 不确定 Simplified Chinese How many people live in your home? ? Please tell me or write a number on the paper ? Not sure 灾害发生以来,您是否已经与住在您家中的所有 人说过话? 否 不确定 是Simplified Chinese Have you been able to talk to all the people that live at your home since the disaster? No Not sure Yes 您拥有住宅,还是租房? ? 拥有 ? 租住 ? 租住有家具的住宅 ? 不确定 Simplified Chinese Do you own or rent where you live? ? Own ? Rent ? Rent with furniture ? Not sure 您的住宅或财产是否受损? 否 不确定 是Simplified Chinese Was your home or property damaged? No Not sure Yes 住宅受损的程度如何? ? 完全损失 ? 严重损坏 ? 轻微损坏 ? 没有受损 ? 不确定 Simplified Chinese Rate the amount of damage to your home. ? Destroyed ? Major Damage ? Minor Damage ? No Damage ? Not sure 您住宅外面的部分是否受损? 否 不确定 是Simplified Chinese Is there damage to the outside parts of your home? No Not sure Yes 如果是,受损的是哪部分? 屋顶 烟囱 墙板或外墙 窗户 以上清单没有列出的其他部分 不确定 Simplified Chinese If yes, what parts were damaged? Roof Chimney Siding or outside walls Windows Other parts not on this list Not sure 住宅内部是否受损? 否 不确定 是Simplified Chinese Was there damage inside the home? No Not sure Yes 是否有食品损毁或损失? 否 不确定 是Simplified Chinese Was food destroyed or lost? No Not sure Yes 是否有厨房用具损毁或损失? 否 不确定 是Simplified Chinese Were kitchen utensils destroyed or lost? No Not sure Yes 是否有客厅家具损毁? 否 不确定 是Simplified Chinese Was living room furniture destroyed? No Not sure Yes 是否有卧室家具损毁? 否 不确定 是Simplified Chinese Was bedroom furniture destroyed? No Not sure Yes 是否有衣服损毁? 否 不确定 是Simplified Chinese Was clothing destroyed? No Not sure Yes 是否有床单损毁? 否 不确定 是Simplified Chinese Were bed sheets destroyed? No Not sure Yes 是否有浴巾损毁? 否 不确定 是Simplified Chinese Were bathroom towels destroyed? No Not sure Yes 您是否损失了药品? 否 不确定 是Simplified Chinese Did you lose any medicines? No Not sure Yes 您是否需要立即获得任何药品? 否 不确定 是Simplified Chinese Do you need any medicines right away? No Not sure Yes 您是否需要很快获得任何药品? 否 不确定 是Simplified Chinese Do you need any medicines soon? No Not sure Yes 能否说出您使用的药品,或者让我看一看药品的 清单? 否 不确定 是Simplified Chinese Can you tell me the medicines you take or show me a list of the names? No Not sure Yes 您家是否有学生? 否 不确定 是 如果是 C 在什么学校上学? Simplified Chinese Is anyone in the family a student? No Not sure Yes If yes, where? 您的住宅是否有保险? 否 不确定 是Simplified Chinese Do you have insurance for your house? No Not sure Yes 您的家具和财产是否有保险? 否 不确定 是Simplified Chinese Do you have insurance for your furniture and belongings? No Not sure Yes 您是否随身携带了保险文件? 否 不确定 是 如果是,请让我看一看保险文件. Simplified Chinese Do you have your insurance papers with you? No Not sure Yes If yes, please show them to me. 您的家庭收入是多少? ?$0C4,999 ?$40,000C59,999 ? $5,000C9,999 ? $60,000或更多 ? $10,000C19,999 ? 不确定 ? $20,000C39,999 Simplified Chinese What is the range of income for your household? ? $0 C $4,999 ? $40,000 C $59,999 ? $5,000 C $9,999 ? $60,000 or more ? $10,000 C $19,999 ? Not sure ? $20,000 C $39,999