ESS FORMS

The following list of forms can be obtained through the ESS Office supply order form. More detailed instructions on their use can be found in the ESS Field Guide, however training from the Support Organizations is required to ensure you have the most thorough understanding of the forms and their purposes.

ESS Referral Form (PEP2395)

Used by Referrals Unit Workers or Level One ESS responders to refer evacuees to suppliers of immediate needs, such as food, clothing, and lodging. The Referral Form instructs suppliers to send their invoices to the provincial government. In many communities, agreements are pre-arranged with suppliers.

ESS Referral Form Record (HR2395A)

Used by ESS Documentation Unit to record the issuance of Referral Forms to Referrals Unit Workers.

Emergency Social Services Rates Sheet (PEP2395R)

This sheet indicates the maximum rates that can be applied to provide for the immediate needs of evacuees. The pre-authorized categories for service include food, lodging, clothing, transportation and incidentals. Any other costs incurred must be paid by the evacuees. ESS workers provide for immediate needs in the most cost-effective manner. For printable version of ESS Rates Sheet (print or photocopy onto pink paper) Click here >>.

ESS Supplier Consent (PEP2396)

Used prior to a disaster to set up agreements with various suppliers to ensure their cooperation during an emergency or disaster, and to provide an instruction sheet of procedures for reimbursement to suppliers, which includes a sample copy of a Referral Form on the reverse. During disaster -- used by Resource Acquisition Workers who identify and allocate resources.

Emergency Social Services (ESS) File (HR2576)
(Registration & Services Record)

Used by Registration Unit Workers in an ESS Reception Centre to register families and record necessary information regarding the identity, location and needs of persons/families affected as a result of an emergency or disaster. Although registration is not mandatory, if the family affected by the disaster requires services through the Reception Centre, they must be registered in order to be referred to suppliers. This form also serves as a file folder for other forms issued to that person/family.

ESS Follow-up Card (HR2576A)
- to be used in conjunction with ESS File

Added to the ESS File by the Documentation unit when follow-up is required with the family.

ESS Out Card (HR2576B)
- to be used in conjunction with ESS File

Used by Documentation Unit in a Reception Centre to indicate where and when a completed ESS File is taken from the Master File in the Documentation Unit.

Change of Information Form (HR2622)

Used to record changes of information of families after they have already registered. This can be done either in person or by phone at a Reception Centre, or by phoning a Central Registry, if activated.

Information Update (HR2671)

Used by ESS Directors or Alternates to advise the ESS Office of changes to their contact information. This form should not be completed for other ESS team members as our database is intended primarily for emergency contact purposes.

Health Canada Inquiry Card (HC/SC 3090)

Used when people are inquiring about relatives living in the area affected by the disaster. This card is usually completed by the Inquiry Unit at a Reception Centre, matches are made and information dispensed either at the Reception Centre or from the Central Registry, if activated.

Page Updated: 2009 April 6