United States                EPA-9O8/4-77-O12
Environmental Protection
Agency
PROCEDURES FOR  EVALUATING HEALTH IMPACTS

RESULTING FROM DEVELOPMENT OF ENERGY
RESOURCES
Region 8                         March  1978
Denver, Colorado

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EPA-908/4-77-012              * " ^ "
                 PROCEDURES FOR EVALUATING
               HEALTH IMPACTS RESULTING FROM
              DEVELOPMENT OF ENERGY RESOURCES
                       Prepared for

              ENVIRONMENTAL PROTECTION AGENCY
                        REGION VIII
                 OFFICE OF ENERGY ACTIVITY
               Under Contract No. 68-01-1949
                            By

             COPLEY INTERNATIONAL CORPORATION
                   7817 Herschel Avenue
                L.a Jolla, California 92037
                  Telephone 714/454-0391
                          Revised
                     November 1, 1977

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                               DISCLAIMER
       This  report has been reviewed by the Office of Energy Activities,
  Region VIII, U. S. Environmental Protection Agency, and approved for
  publication.  Mention of trade names or commercial products does not
  constitute endorsement or recommendation for use.
     Document is available to the public through the National Technical
Information Service, Springfield, Virginia  22161.
                                     11

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                              PREFACE




     This Manual is a compilation of formats, protocols, and proce-


dures that may be used by communities and state agencies to evaluate


health  impacts resulting from the development of energy resources.


The Manual also considers ways of using these evaluations to deve-


lop plans for coping with health impacts.  The Manual is an outgrowth


of a study of health problems experienced by impacted communities


in Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.


Many communities, especially small ones, found that such problems


required actions by both elected officials and the general public


that were new to the community.  There was, and is, a need for guide-


lines and procedures to do the jobs that have to be done.


     Impacted communities have used a variety of approaches in deal-


ing with undesirable health effects.  But accounts of these experieces


and comparisons of their effectiveness are not easily available to


commumities that need to know about them.  In some instances, there


was uncertainty about assistance that might be available and where
•

to get  it.  This Manual was developed to make such information easier


to obtain and to suggest ways that a community may assemble informa-


tion and organize to avoid or overcome undesirable health impacts


from rapid growth.


     The material in this Manual was adapted from many  sources,


The procedures outlined have evolved over a long period and refine^
                                 111

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merits were made by many users, including the authors of this Manual.
The origin of particular procedures and the developers of specific
formats cannot be identified for individual acknowledgment.  Special
mention should be made of the leadership of the Center for Disease
Control, Public Health Service,  U.S.  Department of Health, Education,
and Welfare in formulating procedures for evaluating conditions of
health and sanitation in communities.
                               IV

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                         TABLE OF CONTENTS



                                                             Page

PREFACE 	     i

HOW TO USE THESE PROCEDURES	     1

METHODS AND PROCEDURES	     5

     1. GENERAL INFORMATION  CONCERNING ENERGY
        DEVELOPMENTS	     5

     2. PHYSICAL AND DEMOGRAPHIC PROFILE OF THE
        COMMUNITY	    11

     3. COMMUNITY ENVIRONMENTAL SERVICE 	    18

     4. CURRENT ENVIRONMENTAL CONDITIONS
        (ENVIRONMENTAL SURVEY)	    29

     5. CURRENT STATUS OF HEALTH
        (HEALTH INDEX SURVEY) 	    56

     6. RESOURCES FOR HEALTH SERVICES
        (INVENTORY OF PERSONNEL AND FACILITIES)  	    99

APPLICATIONS OF INFORMATION  	   109

APPENDIX	   117
                                v

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                    HOW TO USE THESE PROCEDURES



What to Use

     Use only the procedures  in this Manual that are needed for your

purpose.  This compilation addresses most of the health-related is-

sues that a community may encounter.  There would seldom, if ever,

be a need to carryout all of  the procedures or complete all of the

tables.  Use this material selectively.   Be sure that you know the

application of information before going to the trouble and expense

of collecting it.  Also, determine what other assessments are being

made in your community and coordinate your efforts.   Try to develop

data and survey instruments that will serve as many purposes as pos-

sible without becoming too cumbersome and difficult to manage.



How to Use the Procedures

     These procedures are designed for use as part of the overall

community effort to deal with impacts.  You probably will find that

some of the procedures would be useful in work that already is under

way.  If you are just beginning to plan your work, you will want to

read Handling Health Impacts  -- Suggestions for Communities Impacted

by Energy Developments  and Action Handbook for Small Communites
       Copley  International Corporation, 1977.  Handling Health  Im-
 pacts  --  Suggestions for Communities Impacted by Energy Developments
 Prepared  for  the Office of Energy Activities, U.S. Environmental
 Protection Agency.  Denver, Colorado.   (Contract 68-01-1949-)
                                -1-

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                    2
Facing Rapid Growth.   Both are available from the Official Energy

Activities, U.S. Environmental Protection Agency, 1860 Lincoln Street,

Denver, Colorado 80203.

     You probably will use these procedures in work carried out by

one or more task forces organized by your Community Impact Committee.

Organization of such a Committee is outlined in the Suggestions and

the Action Handbook.  Planning offices and governmental departments

also may find  some of the procedures useful in their activities.

     After the Community Impact Committee has formed its task forces

and decided on the major areas of activity, these procedures should

be reviewed to determine which would be helpful.  The procedures

outlined are grouped in six parts in the next section, Methods and

Procedures.  To assist you in selecting the parts that may be useful

in your work,  the following is a brief summary of the information

considered:

. Part 1.  General information concerning the energy development, or
           developments, that are expected to have an impact on the
           community.  This information will identify the type of
           development and enable anticipation of the kinds, magni-
           tude, and duration of impacts that may be anticipated
           for the community.

. Part 2.  Information to enable preparation of a physical and demo-
           graphic profile of the community that will aid in defin-
           ing health problems associated with geographic location
           and population growth.  Information will be obtained on
           health problems that have occurred or are currently pre-
           sent in the community, how the community coped with the
           problems, and how effective were such efforts.

. Part 3.  Information concerning current and anticipated needs for
           community environmental services such as water supplies,
           sewage disposal, and solid waste disposal.
     *%
      Briscoe, Mephis,  Murray and Lament.  1977.  Action Handbook
for Small Communities Facing Rapid Growth,  Prepared for the U.S.
Environmental Protection Agency.  (Contract 68-01-3579.)
                                -2-

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  Part 4.  Information relating to current environmental conditions
           that may be employed to ascertain land use by type and
           geographic location; type, conditon, and location of hous-
           ing and other structures; adequacy of residential water
           supplies, sewage disposal, and solid waste storage; and
           premises sanitation.

 . Part 5.  Information concerning the current status of health with
           respect to protection against diseases preventable by
           immunization, occurrence of acute and chronic conditions,
           sources of health services, and impression of residents
           with regard to current health problems and adequacy of
           health services.

 . Part 6.  Information concerning the adequacy of resources to pro-
           vide health services.  This includes determining the a-
           vailability and accessibility of both personnel and fa-
           cilities to meet the health needs of the community in
           timely and practical ways.

You may also want to review the section on Applications of Infor-

mation at the same time to get a general idea as to how the data

and information you collect will be used.

     After you have an indication of the parts  that are helpful,

you will want to review the detailed outlines in the next section.

Keep in mind that the procedures discussed should be adapted to your

needs.  Use only the material that is required  and change it to

serve your purpose.
Where to Get Help

     The state and regional  planning  offices  probably were involved

in organizing the Community  Impact  Committee.   If the State Health

Planning and Development  Agency  and the  Health Systems Agency for

your area have not yet  participated,  you may  wish to get in touch

with these offices to find out what information and assistance is

available if needed.  In  some instances, special programs have been

developed for impacted  communities.   The Appendix is a list of pos-


                                -3-

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sible source of information and assistance.  Some of these agencies
can assist in evaluating the usefulness of the various procedures
for your purpose.

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                      METHODS AND PROCEDURES


1.  GENERAL INFORMATION CONCERNING ENERGY DEVELOPMENTS
     Table 1-1 outlines the information needed concerning each energy
development.   It is necessary to obtain this general view- of each
operation in order to identify all of the communities that may be
affected by each industrial operation and to determine the number pf
different developments that may impact your community.
     The projected employment estimates and information concerning
duration of the activity will aid you in making population estimates.
These data also will be useful later on when you consider whether
arrangements should be made for temporary or permanent residents.
They also provide a guide in preparing schedules for planning and
for implementing programs.
     Much of this material  outlined in Table 1-1 already is avail-
able from published or other readily accessible sources.  The state
planning office or state energy office (see Appendix) probably
will be able to provide a great deal of this information that was
collected in preparing Environmental Impact Statements.   Be sure
to take advantage of available material.
     After getting together as much information as you can, you
then probably will want to  get in touch with representatives of the
industry and obtain the information that was not available from
other sources.   It is  also  a good idea to check the accuracy of

                                -5-

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the information you already have.  This initial contact will give



you the opportunity to meet the industry's representative who has



been designated to work with the community.  If a person has not



been appointed, you can request that a responsible offical be named



as the community contact.



     As indicated above, the information for Table 1-1 usually



is available from state or regional offices.  These are the best



focal points for information concerning all the developments that



may affect your community.  If you do have to collect the infor-



mation locally, it is best to do so by personal contacts.  The use



of a questionnaire is indesirable, especially if requests for the



information are made by correspondence.  Table 1-1 is for you to



complete by using data obtained from various sources,  It is not



designed to be sent to someone to "fill out".

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                                Table 1-1

           General Information Concerning Energy Development



 Name or other designation of the development: 	
 Type of energy:
 Principal developer (responsible firm):

       Address:
 Person or office designated by developer to provide information concerning health

        effects:  Name	

        Address	


 Location of Development

 Location of principal site(s) of operations with relation to proximity of highways,

 established communities,  landmarks, and  other features as needed for precise

 identification:
 Topographic maps of area:

           Name                                      Number
 1.                                                    	
 2.
 3.
 4.

Area of Operations

Latitude	Longitude	.  Size of area	square miles,

or	acres.  Boundaries of area:  Indicated on accompanying map

or described


                                   -7-

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                                  Table 1-1
                                   (cont'd)
Activation and Duration

Actual or anticipated date development or construction was begun or will begin:
Actual or anticipated duration of development or construction phase:

	years	months

                                               	Number of years
Anticipated duration of operation:  Indefinite

Not known
Employment

Actual or anticipated number of employees by years from initiation of activities:


Construction Phase

Year of activity
Date
No. of employees
1
19_

2
19_

3
19_

4
19_

5
«_

6
19__

7
19_

8
19_

Operating Phase
Year of Activity
Date
^o. of employees
1
19_

2
19_

3
19__

4
19_

5
19_

6
19_
-
7
19_

8
19_


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                                 Table 1-1
                                   (cont'd)
 Communities
 New communities planned for construction^
          Name
                                                 No
                     Yes
                                                   Location
 Established communities within 50 miles of the site of development:
Name .Distance Direction Access highway
(miles) or road (Number)
















Available Reports and Other Information

Sources of information prepared by the developer or others relating to the effects of

the development on health and sanitation:

1. Environmental Impact Statement (available);           Yes        No
            Title
Date
Source
                                              -9-

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                                 Table 1-1
                                  (cont'd)
2.  Other sources (available):	Yes	No

            Title                         Date                     Source
                                           -10-

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 2.  PHYSICAL AND DEMOGRAPHIC PROFILE OF THE  COMMUNITY
      You will have frequent need for general  information about
 your community.   It is well to  assemble the material outlined in
 this part and have it available for reference when  required.   Much
 of this information will be needed  when making  some of  the evalua-
 tions outlined later.
      The process of developing  the  proposed profile helps  you gather
 pertinent references and informs  the  task force about the  community
 and its residents.   No particular surveys or  forms  are  suggested.
 The primary sources of material  are  locally available records and
 publications and information obtained  directly  from local  persons.
 An appropriate length  under  each of  the  suggested headings in the
 following outline would be about one or  two double-spaced  typewrit-
 ten pages.   You  may wish to  develop more information about some
 aspects of your  community, or omit altogether some  items in the
 outline.
      The  population data for Table 2-1 usually  can  be obtained
 from the  sources  of demographic data listed in  the  Appendix,
 However,  you may  wish  to  examine such population estimates in light
 of  what you  know  about  employment projections for the industries
 that  affect  your  community.  It is desirable  to discuss  the basis
 for the population  estimates with the persons who prepared them
 and with  the health and regional planners.  Extrapolations from the
 decennial census  are of little value to  impacted communities.
Local employment projections must be considered.  Be  sure  to  get
the best possible information because much of your planning will
be based on the estimated number of people that will be in  the

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community.
     In developing accounts of health conditions in the community,
you probably will want to get some assistance from the health plan-
ners.  Information is desirable concerning the previous health pic-
ture, the current situation, and what may happen as a result of
energy developments.   Obtaining the data indicated in Tables 2-2
and 2-3 is a convenient place to start.  Sources of health infor-
mation are listed in the Appendix.  You problably can get informa-
tion for your county but it is unlikely that data will be available
for specific communities.  County rates can be compared with state
and national rates to give you some idea of relative severity of
health problems in your area.
     Insofar as possible sources of information, including personal
communications, should be indicated by citation in the text and the
title and other information should be listed under References.

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Suggested Ou
tlim
> foi
r De^
;e lop ing
JPh
vs i
ral
and
Demographic
Profile
                     of  the  Community
 Historical  Background

 .   Summary  of  origin and  settlement of the community.
 .   Political and  economic history.
 .   Exploration and  development of energy resources.
 .   Other  factors  pertinent to development of the community
    and  its  natural  resources.

 Physical  Characteristics

 .   Prominent topographic features - description and  location
    with respect to  distance from the community and site  of en-
    ergy development.

    Features associated with precipitous or hazardous  events
    .such as  flooding, torrential rains, tornadoes, persistent
    winds, exposures conducive to blowing dust.

 Climate

    Characteristic climatic features
    Seasonal temperature ranges
    Types  and amounts of precipitation
    Prevailing winds

 Land Use  and Economy

    Agriculture  and industry before and after initiation  of
    energy development

    Relative social and economic significance  of various  types
    of employment and commercial developments

    Recent or anticipated changes caused by energy developments

 Cultural and Social Characteristics

    Ethnic background and composition of the community

    Customs and preferences with respect to development of  nat-
   ural resources, health services,  education, economic growth,
    industrical  developments,  and related factors.

Population

 .  Long-term trends  in  population before energy developments
   were intiated.

   Recent  or anticipated trends as results of energy develop-


                          -13-

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   ments.                       '

   Interpretative narrative based on Data in Table 2-1, Table 2-2,
   Table 2-3, and other available related information.

Health

   General description of health conditions in the community.

   Apparent variations, if any, in health conditions among
   various population groups or in various geographic locations.

   Known or apparent influences of climate and topography on
   health.

   Recognized or suspected relation of occupations to health.

   General trends in morbidity and mortality.

   Identified or suspected causes of changes in rates of di-
   sease and death.

   Problems that have developed as a result of energy develop-
   ment, what measures were taken to cope with them, and how
   effective the measures were.

   Anticipated changes in health conditions as a result of
   energy development.

   Interpretative narrative based on Table 2-2 and Table 2-3
   and other related available data.

References

   Sources of information.  (Notations in text to reports,
   literature, and personal communications,)
                          -14-

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                                                                     Table 2-1



                                                           Trends in Population by Age*

                                                                     1950-1979
                                                                  (County, State)
Number of Persons bv Aare Grou
Year**
1950
1960
1970
1971
1972
1973
1974
1975
1976
1977


< 1












1-4












5-14







-




15-24












25-34












in Years
35-44












45-64












65+












All Ages












 I
I—1
on
           *  Source of data:
           ** Years for which the population Is estimated are indicated with an asterisk.

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                                                    Table 2-2

               Trends in Population, Births, Deaths, Infant Deaths, Fetal Deaths, and Maternal Deaths
                                                    1960-1979
                                                (County, State)
Year
1960
i
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Estimated
Population
July 1











Births
Number











Rate1











Deaths
Number











Rate1











Infant Deaths
Number











Rate2











Fetal Deaths
Number











Rate2











Maternal Deaths
Number











Rate3











 Per 1,000 estimated midyear  population
2Per 1,000 live births
3Per 10,000 live births

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Trends in Numbers and Rates of Deaths Per 100,000 Population by Principal Causes, by Place of Residence       Page -17-
                                            1960-1979
                                        (County, State)








Year
1960
1970
1971
1972
1973
1974
1975
1976
1977
I 1978
1 -\-9-79
Cause* of Death
Diseases of
the Heart
(390-398;
402; 404
410-429)


No.











Rate










\


Malignant
Neoplasms
(140-209)


No.











Rate










,

Cerebro -
vascular
Diseases
(430-438)


No.










,
Rate













Arterio-
sclerosis
(440)


No.











Rate











Influenza
and
Penumonia
(470-474;
480-486)


No.











Rate











Bronchitis ,
Emphysema,
and
Asthma
(490-493)


No.











Rate











Certain
Causes of
Mortality in
Early Infancj
(760-769.2;
769.4-772;
774-778)
No.











Rate











Vll Accidents
ixcept Motor
Vehicle
(E800-E807;
E825-E949)


No.











Rate












Motor
Vehicle
Accidents
(E810-E823)


No.











Rate











I



All
Causes


No.











Rate












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3. COMMUNITY ENVIRONMENTAL SERVICES



     This section outlines procedures for evaluating the major en-



vironmental services available in your community.  For our purpose,



"community environmental services" include water supplies, sewage



disposal, and solid waste disposal.  The best sources of information



are the local offices responsible for these facilities.  In areas



where state agencies have responsibility for planning facilities and



developing standards for communities, these offices should be able



to give you information to supplement that available in your commu-



nity.  State and sub-area planning offices also are involved in



projection of needs for environmental services.  You may also want



to ask these offices for information (see Appendix).  Some state



offices publish annual summaries of data that may be used to com-



plete this section.



     No  forms or  survey  instruments  are  suggested  for  securing



 the  information outlined in  this  section.  All  of  the  data needed



 probably can be obtained from published  sources, public records,



 or public officials.  Tables  similiar  to  those  on  the  following



 pages may be used  for abstracting  data.   Sources of  information



 should be noted on the tables and  a  complete  citation  should be



 given of references.



     These tables  may not be  necessary if  there is only one source



 for  a service.  In these instances,  information may be given in  the



narrative.  Maps of water distribution and sewage  collecting sys-



 tems are  desirable to supplement  the tables.
                               -18-

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Suggested Outline for Evaluating Community Environmental Services
     Water Supplies and Distribution Systems

        Provide interpretative narrative of data in Table 3-1,
        Table 3-2,  and Table 3-3.

        Describe current sources  of domestic water used in the com-
        mutnity, present and projected rates of consumption,  and
        adequacy of supplies.

        Seasonal variations  in use  (summer  vs winter).

        Indicate quality of  domestic water  as  determined by appli-
        cable state or local standards or the  1962 U.S.  Public
        Health Service drinking water standards for domestic  water
        supplies.   Evaluation of  quality should include total dis-
        solved solids,  fluorides, hardness,  and coliform concen-
        trations.

        Describe additional  sources  of domestic water,  if required.

        Description of water distribution systems  including:
          - number  of  residences  to  which services are  provided
          - number  of  residences  to  which the  distribution systems
            are not accessible
          - number  of  residences  that have  access  to the distri-
            bution  system but  are not served by it
          - number  of  vacant building lots  to which distribution
            systems are accessible
          - hydrostatic pressure
          - type of pipe network
          - fire protection  including hydrant  locations,  main
            size, number of  personnel,  number of vehicles,  and com-
            munity  classification by national underwriters  or other
            rating  group.

        Sources of  water for residences  not  served by distribution
        systems.

        Current and anticipated water supply problems such  as
        excess  fluorides, or mineral  content, limited storage ca-
        pacity,  excessive hydraulic  gradient in supply  system,
        zones of inadequate  pressure  and  supply.
                             -19-

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Sewage and Waste Water Treatment

   Provide interpretative narrative for data in Table 3^-4 and
   Table 3-5.

   Description of the types of systems used in the community,
   number of each type,  whether community is completely or
   partially sewered, use of septic tanks, means of effluent
   disposal, and acceptability of the methods from an envi-
   ronmental standpoint.

   Describe annual trends in average sewage flows and seasonal
   variations.

   Outline means for increasing capacity, if needed.

   Describe adequacy of sewage collecting systems including:
     - number of residences to which the collecting systems
       are providing services
     - number of residences to which the collecting systems
       are not accessible
     - number of residences that have access to the collect-
       ing systems but are not served by it
     - number of vacant building lots to which the collecting
       systems are accessible.

   Describe methods of sewage disposal used by premises not
   served by collecting systems.

   Use of septic tanks,  percolation rates, number of systems,
   current or anticipated problems such as bad soil conditions
   and close ground water.
                         -20-

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:Gallons X 1,000
                                                      Table 3-1
                                              Community Water Supplies
                                                     (Community )
Identification
(Name or Location)





Ownership





Source
Type





Capacity
(gal.* /day)





Storage
Type





Capacity
(gal.*)





Treatment
Type





Capacity
(sal.Vday)





Number
of
Users





All Supplies:
Source Storage 1
Capacities J | 1 J

lumber of Users
treatment
i

1 I
                                                                  -21-

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              Table 3-2

Current Trends in Use of Domestic Water
             1950-1978
            (Community)
Number of Users and Average Daily Use (gal. x 1,000)
Year
1950
1960
1970
1971
1972
1973
1974
1975
1976
1977
1978
Residences
Number










\
Amount Used











Businesses
Number











Amount Used











Industries I
Number











Amount Used <



..«i







                    -22-

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                            Table 3-3

Projected Average Daily Requirements for Future Use of Domestic Water
                            1976-1981
                           ( Community)
                  Projected Daily Use (gal. x 1,000/day)
Year
1976
1977
1978
1979
1980
1981
Residential






Business






industry






All Users






                                 -23-

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Solid Waste Disposal

   Provide interpretative narrative for data in Table 3-6
   and Table 3-7.

   Describe services available for collecting garbage and re-
   fuse from residential and commercial premises;
     - number, type, and capacity of collecting vehicles
     - number of collections per week

   Describe suitability of existing methods of disposal-^land
   fill, dump, or others--from an environmental standpoint.

   Evaluation of adequacy of existing systems to meet current
   and future requirements including:
     - number of residences where garbage and refuse collec-
       tions are made
     - number of residences where garbage and refuse collec-
       tions are not made
     - number of vacant building lots on route where refuse
       and garbage collections are made
     - current and projected adequacy of disposal site(s)

   Indicate methods of solid waste disposal used where collec-
   tions are not made through an organized system.

   Current or potential problems with land fill or dump, such
   as, drainage, ground water contaimination, odor, and smoke.

   Availability of additional land, limitations to use.

Air Pollution

   Indicate current standards applicable to the community.

   Describe location of air monitoring stations that reflect
   conditions in the community.

   Discuss relations of applicable measurements to standards.
                         -24-

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                                               Table 3-4
                   Municipal Facilities for Sewage and Waste Water Treatment
(Community)
Identification
(Name or Location)





Type





Daily flows (gal. x 1,000/day)
Current average





Capacity





Means of effluent disposal





All Facilities:




Current average daily flow:




Capacity:
                                                     -25-

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                              Table 3-5

              Current and Projected Trend in Sewage Flows
                              1950-1981
                            (Community)
Year* Population Average Number of Gallons ( x 1, 000) /Day
1950
1960
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981


























*Years for which the population is estimated, indicate with an asterisk.
                                     -26-

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                                Table 3-6




              Municipal Facilities for Solid Waste Disposal
                              (Community)
Identification
(Name or Location)





Ownership





Type





Daily Use (tons x 1,000/dai
Current





Capacity





All Facilities:




Current average daily use:




Capacity
                                 -27-

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                         Table 3-7

  Current and Projected Trends in Production of Solid Waste
                         1950-1981
                       (Community)
Year*
1950
I960
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
Population














Tons /Day ( x 1, 000 )














* Years for which the population is estimated,  indicate with an asterisk.
                                -28-

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4. CURRENT ENVIRONMENTAL CONDITIONS (ENVIRONMENTAL SURVEY)

     You may find that not enough information is available  for  your

task force to determine the extent of unsatisfactory environmental

conditions.  This situation is most likely to develop when  rapid

population growth has already commenced.  A block-by-block  survey

is a relatively quick and inexpensive way to accumulate data  that

will be useful for a variety of planning activities.  The procedures

outlined below will enable you to gather information concerning the

following factors :

        Location and extent of various types of land use

        Types and condition of dwelling unit

        Source of domestic water

        Methods and adequacy of sewage disposal

        Methods and adequacy of storage and disposal of solid wastes

        Location of breeding places and harborage of vectors and
        reservoirs of disease-producing agents

        Location of dilapidated structures

        Location of objectionable environmental conditions



Maps

     Your first need for this  activity is an accurate map of the

community.   Sources of maps  are the local government offices, such

as the mayor's and tax assessor's or the offices providing envi-

ronmental services.   Maps  of water and sewer systems may be suit-

able for use  in the environmental survey.  Other possiblities are

the area planning  offices  and  health planning agencies.   The state

highway office will be able  to offer suggestions and may be able

to provide  aerial photographs  at  a scale suitable for use in the


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environmental survey,  If maps are not available from these sources,



satisfactory ones can be prepared with the use of an accurate, hand-



held compass and automobile odometer.







Identification o:f Blocks



     The block in the community should be identified by consecutive



numbers beginning at the northwest extent of the area.  Blocks to



the east are numbered sequentially until the community limit is



reached.  The series of numbers is continued with the second tier



and subsequent tiers of blocks.  The numbers for each tier begin



at the western limit, and consecutive numbers are assigned to the



blocks eastward.



     In larger communities, or when otherwise convenient, the com-



munity may first be subdivided into sectors delineated by natural



or cultural features, e.g., rivers, railroad tracks, highways or



other major thoroughfares, parks, business districts, or obvious.



socioeconomic areas.  If this is done, a letter is assigned to



each sector and blocks within the sectors are numbered, as outlined



above.  In this case, block would be designated by both a letter



and a number,  e.g., A-l, A-2, B-l, B^-2,  etc.  This system is useful



in distinguishing sections, or neighborhoods, of the community



that obviously have homogenous characteristics, e.g., a mobile



home community, a "tent city," or a grossly deteriorated area.



     Census tracts are designated for few impacted communities.



If they are available, however, use them by all means rather than



devise another system.
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Field Observation
     Each block  in  the area to be evaluated is inspected  from an
automobile driven at slow speed.  The inspector records his  obser-
vations  and  indicates to the driver the appropriate rate  of  travel
and when stops are  necessary.  The survey should begin at the north-
west corner  of each block, proceed eastward, and then continue by
making right turns  to keep the area being surveyed to the inspector's
right.   Only general features, such as the type of land use  and
other easily observable aspects, are recorded during the  drive
around the block.   If there is an alley, observation of other
conditions then  are made by driving through the alley.  When ade-
quate observations  cannot be made from the automobile, the inspec-
tor should walk  to  secure a better view.  Unless special  arrange-
ments have been made, the inspector ordinarily will not enter pri-
vate property.
     In  rapidly  expanding communities, mobile and temporary  housing,
as well  as other types,  may develop in areas where streets and
blocks have not been defined.   In these cases,  the inspector  should
indicate the location of the area as accurately as possible  on the
community map and identify it with an appropriate notation so that
the relevant Environmental Survey Form can be related to  the  area.
(A recommended  Environmental Survey Form and tables for compiling
data are provided at the end of this section (see Figure  4-1  and
Tables  4-1  through 4-8.)   Such areas are evaluated and data  trans-
ferred  to the data consolidation forms,  described below,   as  are
the data for  defined blocks.   The block outline on the Environmen-
tal Survey  Form will have  to be modified or a  separate sketch pre-

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pared.  If the area is homogenous, the number of housing units



may be noted and the area evaluated as a whole.







Use of the Environmental Survey Form



     Observations are recorded on the form illustrated in Figure



4-1.  The block number and name of the intersecting streets at the



northwest corner, where observations commence, are entered first



on the form.  The name of the other boundary streets are noted as



they are observed.  Names are entered from the community map if



there are no street signs.  During the course of the inspection,



variations in the shape of the block, streams, alleys, and other



features are noted.  A rough approximation of the apparent property



lines of individual lots is recorded on the form during the inspec-



tion.  The purpose is not to identify boundaries as much as to in-



dicate the premises to which the symbols pertain.  This assures



assigning the code symbols to the correct location when data are



transferred to summary forms or illustrations,  Each lot is num-



bered consecutively from the start of survey of each block.  The



lot on the northwest corner is number 1, the next nvmber 2, and so



on.  If house numbers are visible they should be recorded, as well.



No particular effort should be made, however, to ascertain the spe-



cific addresses for houses on which numbers are not displayed,



     If is advisable to follow the same pattern in recording the



code symbols on the survey form.  Both recording and transcription



are facilitated if observations are made and recorded in the same



sequence for each premise.  The arrangement shown in Table 4^1 sug-



gests the following order of observations:





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      1.   A determination  is made  as  to whether  or not  the use is
          residential  or non-residential.
      2.   If residential,  the  type of dwelling unit  it  identified
          and recorded.
      3.   If non-residential,  the  type of use is observed  and re-
          corded.
      4.   The condition of the principal structure is determined and
          recorded.
      5,   The method of solid  waste storage is observed and recorded.
      6.   The type of  sewage disposal  is observed and recorded.
      7.   The source of domestic water is determined and recorded.
      8.   The condition of the premises is observed, and specific
          deficiencies are noted and recorded.
      The  appropriate  symbols  are  always recorded on the form in
 the  same  sequence.  The first is  recorded at the place on the form
 depicting the front (streetside)  of the property being inspected.
 The  other symbols are recorded sequentially, in the order indicated
 above, toward the place on the form indicating the  back of the  pre-
 mises.  An example of a completed form is illustrated  in  Figure 4-2.

 Code for  Land Use and Environmental Conditions
      Table 4-1 lists the  symbols used for recording land  use  and
 environmental conditions  observed during the inspection.   The in-
 spector should become familiar with these symbols so that constant
 reference  to  the list is not necessary.   It will be noted that
 the  letters used for each symbol usually suggest the factors  and
 conditions  to be evaluated.   In instances when this is  not  done,
 other letters will be necessary to avoid repetition.   Table 4-1
 should be duplicated and kept on the clipboard with the Environ-
mental Survey Forms.   For specific local needs,  additions or mod-
                               -33-

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ifications to  the  code may be desirable to measure factors or con-



ditions not anticipated.  Duplication of symbols already used in



the code should be avoided when making changes or additions.  In-



formation concerning observations or impressions not considered



in the code should be noted on the form when desirable for clari-



fication or to provide more detail.  Procedures for use of the



code in recording  observations are given in Table 4-2.







Consolidation  of Data



     The data  obtained from individual premises is consolidated



to characterize conditions for each block.  This should first be



done on the Environmental Survey Form by entering the totals for



the block in the spaces provided at the bottom of the forms.



The data for each  block then should be transferred to summary forms



Tables 4-3, 4-4, and 4-5 illustrate forms useful for this purpose.



Preferably, the field data should be transferred to these forms



by the inspector the same day or the day following the survey.



This facilitates recall of abbreviations and permits repeat visits„



if required, while the survey is in progress in nearby areas.  It



should be emphasized that completion of these forms is an inter-



mediate step in analysis of data.  Their usefulness in reports



and for public display is limited.







Display of Information



     When the data are consolidated, the information developed



from them should be displayed on maps of suitable size and scale.



The maps used for  the enumeration of blocks may be adaptable for





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 this purpose.  The overall dimension should not exceed 3 by 4  feet.
 The scale  should enable depiction of blocks at a size of 1/2 to
 3/4 inch for  the shortest dimension.  In some communities, a map
 for the entire area prepared at a small scale may be necessary for
 orientation.  Maps of the sectors that comprise the area then  can
 be prepared on a larger scale for plotting information.  The se-
 lection of scales should be governed to a large extent by the  avail'
 ability of maps of community environmental services and other  maps
 of the community-  Information also should be sought from the  state
 and local  health planning agencies concerning formats and symbols
 for depicting environmental conditions relating to health and  san-
 itation.   The list of selected references following this section
 also may be helpful for this purpose.
     A convenient procedure is to use a basic map on which is  in-
 dicated the outline of blocks, names of streets, and prominent
 areas or landmarks.   The maps may be reproduced in sufficient  quan-
 tity for plotting each group of conditions, such as condition  of
 housing, land use,  and sanitiation services, on separate maps.
 An alternative is to overlay the basic map with clear acetate
 sheets on which the various conditions are plotted.  The latter
 has the advantage of enabling visual presentation of combinations
 of conditions by superimposing the sheets depicting the various
 conditions.
     The mechanical  processes of preparing a basic map, plotting
 data,  and choices of symbols and colors are largely the preference
 of the preparer.   It is  advisable, however, to also review these
matters with the local health planning agencies to determine if
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conventions specifying these steps have been adopted.  This will

assure uniformity and compatibility with similar work in the area.

Generally, commercially available acetate transfers used in draft-

ing are best for symbols and color blocks.  Legend symbols, such

as those used on maps and for other purposes, are available in a

variety of styles that may be used for this purpose.  Colors or

shading patterns also are available in many forms.  In using trans-

ferable colors or shading patterns, the worst conditions ususally

are depicted by red or a dark pattern, the best conditions by

blue or a light pattern, and intermediate conditions by intergrades

of colors or shades between these.

     The following types of information should be displayed on maps,

Separate maps may be used for each factor, or related ones may be

displayed on the same maps.

        Land use

        Types of housing

        Water distribution system and sources of water for domes-
        tic use

        Sewerage collecting system and type of sewage disposal

        Land drainage

        Solid waste storage

        Environmental deficiencies

     Local conditions and needs may indicate the necessity of other

displays or suggest that some of those listed would not be useful.

Only those required for evaluating conditions'.,of • ihe.a 1 thl,and Jsag-

itation should be included.  The purpose, in this context, is not

to develop an exhaustive characterization of all aspects of the

community.


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     The following general suggestions are offered for preparation
of the maps listed above.  In determining the types of maps  to be
prepared, consideration should be given to the possibility of en-
hancing their usefulness by depicting combinations of factors on
the  same map.  For example, condition of the physical structures
and  sanitary conditions often can be illustrated together to ad-
vantage.  The quality and condition of housing is correlated with
well-maintained environs and presence of adequate community envi-
ronmental services.  Local circumstances will suggest when such
combination of illustrations is desirable.   For clarity and con-
venience, each of the principal types of maps are considered se-
parately in these suggestions.
     Land Use.  Illustrations of land use may be prepared from the
data in Table 4-3.  Unless there are indications otherwise, the
mininum number of categories should be depicted in the initial pre-
sentation.   In many instances,  residential  and non-residential use
may  suffice.  In communities where population is growing rapidly,
categories that distinguish between temporary, mobile, and per-
manent dwellings may be desirable.  Locations of vacant areas and
recreational areas are useful in planning for community growth.
The  information accumulated,  as outlined in Parts 1 through 3
will be useful in determining the categories to be included in
the  initial illustration of land use.
     Difficulty is seldom encountered in determining whether a
given block is primarily residential or non-residential.   A vi-
sual comparison of the data in  the total columns of Table 4-3 is
usually adequate without a separate tabulation and calculation.

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If t^he proportion of business and non-business is about the same,
or if either use is as much as 25 percent of the total, the data
on the survey form for the block in question usually will indicate
the segments of the block where a specific use clearly is dominat,
The appropriate color or shading pattern then can be applied to
that segment.  Use of more than one indicator for a block is help-
ful to illustrate areas where transition in types of land use oc-
curs.
     Type of Housing.  Data concerning type of housing also is
available from Table 4-3.  Such information is especially useful
for a community where rapid growth has occurred or is in progress.
In such instances, temporary or mobile housing may be concentrated
or interspersed with more permanent types of dwellings.  It is im-
portant to relate these areas to availability of community envi-
ronmental services (Part 3).   if tetnporary or mobile  housing
is present adjacent to or in established communities where streets
have not been constructed and, consequently, individual blocks are
not delineated, the approximate boundaries of such areas should
be delineated on the display maps.  If the area is generally homo-
genous with respect to type and condition of housing, environmen-
tal services, and environmental conditions, the entire area may
be mapped  as would be an individual block.
     A suitable color code should be selected for the type of hous-
ing to be illustrated on the map.  Seldom, if ever, will it be
necessary to depict all of the types of housing indicated on
Table 4-3.  The important distinctions to make are between the per-
manent type dwelling and the temporary or mobile types that fre-

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quently occur in "boom town" situations.  As indicated above,
a blue color or a light shading pattern should be used to represent
the most desirable type of housing and red or a dark shading pat-
tern for the least desirable.  Intermediate types should be de-
picted by intermediate colors or shadings.   When more than 75 per-
cent of housing is of one type, the entire block should be shown
as that type.  Multiple types can be represented by combinations
of colors or shading patterns, as suggested for indicating types
of land use.  Because dwelling units may be sparsely distributed
in some locations within communities, especially on the periphery,
a symbol code should also be used for depicting location of one
or a few units.   The number of units to be indicated individually
will depend on local circumstances.  Generally, fewer than five
units should be shown by a separate symbol for each unit.  This
procedure is convenient when the block contains a preponderance
of one type but also has a few of another.   The latter can be
shown individually by superimposing the .appropriate symbol on the
background indicating the predominant type.
     Condition of Housing.  Data from Table 4-4 are used to illus-
trate condition of housing.   Note that condition of the dwelling
unit is being illustrated without reference to type of unit.
As indicated above,  in some  instances, it may be convenient and
desirable to illustrate types and conditions on the same map,
     As with the illustrations previously considered,  the objec-
tive is to reflect predominant conditions for the block.   If 75
percent or more  of the dwelling units on a  block are in the same
condition,  and if the others  are not extremely different, it  gen-

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erally is preferable to apply the appropriate indicator, color or
shading pattern, to entire block.  Multiple indicators can be used,
as mentioned in connection with the other maps.  Also, the condi-
tion of one or a few units that differ from that of the others
on the block may be shown by superimposing a symbol or another
indicator of appropriate size at the proper location on the indi-
cator that depicts the prevalent conditions on the block.
     The number of categories used to describe conditions of hous-
ing will be determined by the extent of detail needed in the com-
munity-  Generally, three categories are sufficient:  good, fair,
and poor.  The classification of "new" and "good repair" used in
Table 4-4 would be placed in the "good" category, "minor repairs"
in the "fair" category, and "extensive repairs" and "dilapidated"
in "poor".  Good conditions should be depicted by a blue color or
light shading pattern, fair by yellow or an intermediate shading
pattern, and poor by red or a heavy shading pattern.
     Domestic Water.  Sources of domestic water may be effectively
illustrated on a map that also indicates the municipal water dis-
tribution systam(s) .  Data for preparation of this :uap will be
available from the work outlined in  Part  3  and  from those  re-
corded in Table 4-5.  By illustrating these two sets of data to-
gether,  the possibility, of making  connections  to  the  existing
system, or extending the system to unserved residences, can easily
be visualized.
     Symbols used on the map should be selected to reflect the
municipal water supply as the best situation and an open'well as
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the  least desirable,  A well with a pump should be indicated  as
an intermediate condition.
      Sewage Disposal.  Illustration of methods of sewage  disposal
and  the  sewage collecting system also may be illustrated  advanta-
geously  on the same map.  The sources of data are Part 3 and
Table 4-5.  The methods of display should be essentially  the  same
as for the sources of water.  Usually, only three categories  are
required.  Indoor plumbing should be depicted as the best condi-
tion,  no facilities for sewage disposal as the worst, and privy
or frostproof toilet as the intermediate condition.  Local cir-
cumstances and requirements may, of course, necessitate other
categories,
      Solid Wastes,  In communities where collection, disposal,
or storage of solid wastes is a significant problem, methods of
refuse storage on premises should be illustrated on a separate
map.   In other circumstances, these data may be included on the
same  map illustrating other environmental conditions.  Three.cate-
gories usually are adequate.  The best situation is covered con-
tainers  of satisfactory construction, the worst is unconfined litter
or burning, and any inadequate container is intermediate,  Data
are obtained from Table 4-5.
      Environmental Conditions.   The illustration of environmental
conditions from the data in Table 4-4 may be simple or detailed,
depending on local requirements.  It seldom is necessary to depict
the category of "well-kept" on the map.   In some cases, only an
indication of blocks with any objectionable sanitary conditions
may be adequate without specifically identifying the types of con-

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ditions.  Other circumstances may require detailed illustration



by type and specific location.  If distinction of types is not



indicated, any means of identifying the blocks involved is appro-



priate.  For example, a red overlay may be used or a color or sym-



bol code can be devised.



     Where identification of the type of condition is desirable,



each type should be assigned a specific indicator or symbol.



These may be used singly or in combinations.  Symbols have the ad-



vantage that location can be approximated by appropriate place-



ment of the symbol.  In some instances, it is desirable to develop



a map illustrating a single condition or specific combination of



conditions, for example, the location of lots overgrown with weeds



or the location of lots with large animals.  The data consolidated



in Table 4-5 are sufficiently detailed for this,



Use of Illustrations



     The maps prepared as outlined above have obvious application



of making a forceful display of sanitary conditions of the environ-



ment.  When presented in combination with the illustration prepared



from the data related to health conditions (Part 3) a convinc-



ing picture of the interrelation of health and environmental fac-



tors is developed.  The maps also are operational tools that enable



determination of the relative magnitude of problems and assignment



of priorities for remedial programs.  Together with other informa-



tion, the maps provide indications of the types of corrective and



preventive measures.  For example, desirable locations of health



services and advantageous extensions of community environmental



services can be determined from them.  The maps also aid in eval-
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uating programs and provide the means for easy reassessment of
conditions.
     When the maps depicting land use and condition of housing
are prepared, several prominent characteristics of the community
become apparent that may not have been as evident or as well defined
For example, the various socioeconomic sectors -- industrial, com-
mercial, and residential areas -- will be clearly delineated.
The other prominent types of land use also will be evident.
Areas that should be selected for early or intensive attention
will be apparent, as will be parts of the community where specific
problems are less significant.

Tabular Compilations
     The data consolidated in Table 4-3,  4-4,  and 4-5 also provide
the basis for tabular presentations of statistical information.
These are necessary for quantitation of conditions and are essen-
tial to complement the illustrative information on the maps.  Both
the maps and the tabular material are needed for effective analy-
sis .
     The tables are generally organized to enable comparisons of
conditions in various sectors or neighborhoods,  for various types
of housing, and other factors.   Some examples  of general forms of
arrangements are illustrated in Tables 4-6,  4-7, and 4-8.  Local
requirements and conditions  will suggest  the factors to be consi-
dered and the appropriate arrangement of  numerical information.
The following are some  examples:
     .   Distribution of residential units,  by  type,  by socioeco-
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         nomic area.

         Condition of housing, by sector or neighborhood.

         Environmental deficiencies,  by type,  by sector or neigh-
         borhood, by type of dwelling.

         Source of water for domestic use, by type, by sector or
         neighborhood, by type of dwelling.

         Method of sewage disposal, by type, by sector or neigh-
         borhood, by type of dwelling.

         Land drainage.

         Environmental deficiencies,  by sector or neighborhood, by
         type of dwelling.

REFERENCES

Public Health Service.  Community block survey and socioeconomic
     stratification.   National Communicable Disease Center.
     Atlanta, Georgia.

Institute of Rural Environmental Health, Colorado State University.
     Environmental Sutdy for Health Planning.   Montezuma County,
     Colorado, 1972.   Fort Collins, Colorado.

Wyoming Department of Health and Social Services.  Community Health
     Analysis for Sheridan, Wyoming,  March 1970.  Office of Compre-
     hensive Health Planning.

Public Health Service.  Community Disease Control Demonstrations.
     National Communicable Disease Center,  Atlanta, Georgia.

Public Health Service.  Community Disease and Immu?aization Survey.
     National Communicable Disease Center.  Atlanta,. Georgia,
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                                                                             Table 4-1

                                                         Codes for Land Use and Environmental Conditions
LAND USE

Residential

Units attached to Integral foundations:

R-l   Single residence
R-2   Double residence (Duplex)
R-3   Multiple residence (Apartment building)
M    Motel
H     Hotel

Residential units not permanently affixed to integral foundations:

MH   Mobile home
HT   House trailer
Non-Residential
                                                            MULTIPLE USE (combination of residential and non-residential use)
 BO
 BN
 10
 IN
 OB
 PU
 I
 R
 V
 ON
Business producing any type of organic refuse
Business not producing any type of organic refuse
Industry producing any type of organic waste
Industry not producing any type of organic waste
Office building
Public utility
Institution
Recreational area
Vacant lot or area
Other -  indicate type
Condition of Structure

NW   New
GR   Good repair
MR   Needs minor repairs
ER   Needs extensive repairs
DL   Dilapidated
   -V Vacant

Solid Waste Storage

S     Satisfactory container
U     Unsatisfactory container
L     Unconfined litter
B  .  Burning
OT   Other - indicate type
NO   Not observed - unable to determine

Sewage Disposal

P     Privy
FP   Frost-proof toilet
ID    Indoor plumbing
OS   Other - indicate type
NN   Not observed - unable to determine
Water Source

W    Open well
WP   Well with pump
CW   Municipal supply
OW   Other - indicate type
                                                                                                             Condition of Premises

                                                                                                             WK   Well kept
                                                                                                             DO   Dilapidated outbuildings
                                                                                                             L]    Large items  of junk
                                                                                                             OG   Overgrown weeds
                                                                                                             RH   Rodent harborage
                                                                                                             SW   Standing water
                                                                                                             ST   Septic tank overflow
                                                                                                             DC   Dogs or cats - indicate number observed
                                                                                                             CH   Chickens or  other domestic fowl
                                                                                                             HR   Horses
                                                                                                             CO   Cows
                                                                                                             PI     Pigs
                                                                                                             GA   Goats
                                                                                                             AP   Air pollution sources
                                                                                                             OO   Other - indicate  other objectionable
                                                                                                                   conditions
                                                                                              NO   not observed - unable to determine
                                                                                   -45-

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                               Table 4-2

                  Directions for Recording Observations



LAND USE

       This information is needed to determine the principal purpose for which

each block of the community is being used in order that the adequacy of community

sanitation services can be determined  and data obtained for planning additional

services where needed.
Residential Units - any type of dwelling unit used for shelter by the population.  A
       distinction is made between units attached to integral foundations and those
       which can be moved without dismantling or disturbing the structural inte-
       grity of the unit.

       Units Attached to Integral Foundations

       R-l  Single residence intended for occupancy by one household group.

       R-2  Double residence - a duplex or other unit, such as an apartment in
            a private residence, intended for occupancy by two household groups.

       R-3  Multiple residence - intended for occupancy by three or more house-
            hold units.  No special efforts should be made to determine the  precise
            number of units,but if an estimate is possible, indicate the estimated
            number by R-3 (6), R-3 (14), etc.

       M   Motel  - indicate known or estimated number of units  by M-12, M-25,
            etc.

       H    Hotel - indicate known or estimated number of rooms by H-10,  H-23,
            etc.

       Units Not Attached to Integral Foundations

       MH  Mobile home - a movable unit not designed for frequent relocation.
            Often has awnings attached or is located adjacent to a sheltered con-
            crete slab.  Usually provided with electrical,  water,  and sewer
            connections and solid waste is collected.
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            If located on a single lot, evaluate as a separate residence.

            If a mobile home community, sketch boundaries on survey form;
            indicate number of units by MH-6, MH-20, etc.; and evaluate com-
            munity as a single premise.

            Indicate the number of vacant spaces if apparent, e.g.  6-V.

       HT  House trailer - (include Motor Homes in mis category)  distinguished
            from a mobile home by ease of transportation and anticipated greater
            frequency of relocation.  Often provided with electrical, water, and
            sewage connection at parking site and, additionally, has self-contained
            water reservoir and sewage holding tank.

            If located on a separate lot,  evaluate as  a single residence. Indicate
            by -L if apparently Las been parked for more than two weeks.

            If located in a trailer park, sketch park boundaries on survey form;
            indicate number of units by HT-10,  HT-13, HT-25, etc.,  and evaluate
            park as a single premise.  Indicate the number of vacant spaces if
            apparent, e.g.  5-V.

       OM  Other mobile or easily movable residential units, such as tents,
            motor homes, or campers.  If located on a separate lot,  indicate
            type and evaluate as a  separate premise.  This type of unit usually
            will be included in evaluation of trailer parks.
Non-residential Units
       BO   Business establishments where any type of organic refuse is produced.
            This category includes restaurants, food stores, flower shops, and
            other businesses that discard putrescible material

       BN   Business establishments where organic refuse is not produced.  Ex-
            amples are service stations,  offices, theaters, garages, machine
            shops, parking  lots,  warehouses, etc.

       IO   Industrial establishments where any type of organic waste is pro-
            duced.  For example, canning plants,  meat processing plants, fruit
            and vegetable packing sheds.

       IN   Industrial establishments where organic wastes are not produced.
            This category includes  manufacturing and processing operations.
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Solid Waste Storage

        S    Satisfactory containers - covered metal or plastic cans, covered
             storage bins, or other arrangements that prevent access by flies
             and rodents.

        U    Unsatisfactory containers - uncovered containers such as oil drums
             or boxes that enable access of flies and rodents,

        L    Unconfined litter - refuse and trash discarded without apparent at-
             tempt to confine.

        B    Burning - evidence of trash disposal by burning in an incinerator,
             improvised metal container, or on the ground.

       OT   Other type of storage - indicate type.

       NO   Not observed - unable to determine method of refuse storage,  if any,


Sewage Disposal

        P    Privy.

       FP    Frost-proof toilet.

       ID    Indoor plumbing - this cannot be determined conclusively without
             questions or inspection,  but the presence of vent pipe and evidence
             of municipal water supply are indicative.

       OS    Other - specify type.

       NN    Not observed - unable to determine.


Conditions of Premises
       WK  Well-kept.  Appearance of yard or lot indicates regular maintenance.

       DO  Dilapidated outbuildings - sheds, barns, chicken coop, or other struc-
            tures that are deteriorating.

       LJ   Large items of junk - abandoned vehicles or other machines, refrig-
            erators or other appliances, or other articles for which a truck would
            be needed to transport. Indicate type if identifiable.
                                -48-

-------
       OB   Office buildings. Indicate if specific purpose is obvious, such as:
            bank,  courthouse, county office,  city hall, etc.

       PU   Public utilities. Area used  by government or other organization for
            public services.  Examples:  power distribution sub-stations,  air
            monitoring stations, refuse disposal sites,  health department.  Where
            practical,  the specific use should  be indicated on the form.

        I   Institution. Indicate type such as  school, church,  college, hospital.

        R   Recreational area. Any area designed for decorative or recreational
            purposes.  Indicate type of use when apparent; for  example, park,
            playground, golf course.

        V   Vacant lot or area.  If agricultural or pasture use,  indicate by V-A.

       ON   Other non-residential use.  Indicate type.
Multiple Use - indicates structures used for both residential and business purposes
       by combinations of symbols for residences and businesses.  For example,
       a combination single-family residence and grocery store would be indicated
       R-l - BO ; a combination single-family residence and beauty shop would be
       indicated R-l - BN.
Condition of Structure
       NW  New structure - obviously recently built or recently placed on location.

       GR  Good repair - no apparent sign of neglect or deterioration.

       MR  Needs minor repairs - no structural defects or hazards observed but
            some v/ork needs to  be done to prevent deterioration.  For  example,
            peeling paint, torn screens, broken window,  etc.

       ER  Needs extensive repairs - value of  basic structure justifies cost of
            major repairs.  For example, roof needs replacing and entire struc-
            ture needs painting.

       DL  Dilapidated - value of basic structure does not warrant cost of exten-
            sive repairs.

       -V   Add to above symbols when structure is vacant.
                                -49-

-------
 OG   Overgrown weeds - the yard or lot is covered or partially so by
      uncontrolled growth of vegetation.

 RH   Rodent harborage - rubble or other debris, unstacked lumber,  or
      other material observed that could provide harborage for mice
      and rats.

 SW   Standing water - indicate permanent or semi-permanent that could
      provide breeding places for mosquitoes.  Do  not record casual
      water resulting from recent rain unless the place of accumulation
      appears likely to persist.

 ST   Septic tank overflow -  usually can be identified by evidence of flow
      from beneath surface.

 DC   Dogs or cats - indicate which or both by circling appropriate letter
      or both letters.  Indicate number observed.

 CH   Chickens  or other  domestic fowl - indicate number observed and
      whether in coop  or  loose by -C or -L.

 HR   Horses - indicate number observed.

 CO   Cows - indicate  number observed.

 PI    Pigs

 GA   Goats

 AP    Air pollution - any  activities such as burning that are sources of
      air pollution.

OO    Other - any other objectional conditions observed.
                          -50-

-------
                                                                     Table 4-3
Page
of
                                                                     Summary
                                                                Environmental Survey

                                                                   Type of Land Use
Community_

State
Sector
Inspector
Residential
Block
Number










Single
Residence










Double
Residence










Multiple
Residence*
N U









1
s
N U









*
2
NU









Mobile
Home










House
Trailer










Other-
Indicate Type










1










Non-Residential
Business ]
Organic |










Business j
Not Organic j










Industry 1
Organic j










Industry
Not Organic










2

o
J *
I a
S<:
> s










Other-
Indicate Type










1
^










                                                                                                          Multiple
                                                                                                            Use
               Total
                all
              Premises
     *Enter number of structures (N) and number of units (U),  if determined.
                                                                           -SI-

-------
Sector
          Table 4-4

          Summary
    Environmental Survey

Physical Condition of Structure
            and
Sanitarv Condition of Premises
Inspector
-
Block
'umber


-


-


-


-


-

Physical Condition
Number of Structures

O &
















Minor
Repairs
















Extensive
Repairs
















Dilapidated
















Vacant


































Sanitary Condition
Number of Premises
i — 1 4-'
1 8*
£ w
















Dilapidated
Outbuildings
















CO
6
S
••H
Q) -^
bO S
t-f -2,
tl <+-i
i-l 0
















Overgrown
Weeds
















Rodent
Harborage
















Standing
Water
















Septic
Overflow
















i
as
O Ctf
Q U
















Chickens
















Horses
















CO
0
O
















IAir pollution
sources
















1 Other Objec-
i tionable







*








                                            -52-

-------
                                                                 Page
                                          of
Inspector

Sector
      Table 4-5

      Summary
Environmental Survey
Community_

State
                  Water Supply, Sewage Disposal, Solid Waste Storage
                                         Number of Premises

_ Block
Number

—



—




. —


—

Water
Sources
c! .-<
&t













•8
1
- £
1!













Municipal
Supply













H *x
M I
of













Not
Observed


















Sewage
Disposal
>.
£
)H
P-,













y-i
0
2
a
SI
!-l O
PH E-













Indoor
Plumbing













Is
0 H













Not
Observed

























Solid Waste
Storage
Satisfactory
Container













Unsatisfactory
Container













Unconfined
Litter













Burning













Other -
Type













                                           -53-

-------
                                 Figure 4-1

                            Environmental Survey
J
                      C om m unity	
          Sector     Block No.      Date
Inspector
                        L_
~I
                              BLOCK SUMMARY
                       r
Residential

V
Single
Residrnc


it
Double
Resldenc

/g

1.1
N

U



|
N

U



2
S
N

U



— v
II



House
Trailer

1
FH
Other-
Indicate



(2

Non- Residential


Business
Organic

o

Business
Not Or^a



Industry
Organic

u

Industry
Not OTR?



c1
•
11


d
Institutio

?

Recreati
Area



M
J* M
> O

^
[-
Other-
Indicate



(2




S-
'S Si


S

1-S
S3

Physical Condition
Number of Structures


1



"5 S
0 &
p o
O ert



Minor
Repairs



Extensiv
Repairs


"S
"a.
n



Vacant

Sanitary Condition
Number of Premirses


— 1 4-1


QJ C
Dllapida
Outbuild



&!
J o


s
Over^ro
Weeds


&
Rodent
Harbora



Standing
Water



II



to 2


« 5
'(U
"o Q*



m
1

•
M
- n
O 0
u o

!_
•§
Air pollu
sources

i
S
Other Ob
lions Me

Water Sources


II



Well with
Pump



i
o i1
11



i*
0 H



Not
Observed




>,
>
2

bewage Disposal


a,
w a
ss
u* p



Zndoor
Plumbing



h
O H



Not
Observed

Solid Waste Storage


Satisfacuary
Container



Unsatisfacto
Container



Urconfined
Litter



S1



i*
O !-



I I

                                       -54-

-------
J    I
Sector
 1W
                               Figure 4-2

                          Environmental Survey

                     Community   Coa./vfi'//c
                   Block "» jj_
Oeoui
            /
          £-1
          CM
          IV /<
                     2,
                   K-Z
                   ctv
                   wx.
                                4-io
                      I D

                      VtK
ft-1
 MR
 (J
 ID
cvf
                                             Do
                            Wf>

                             8
                                     C\ftf
                                     U

                                     Ki

                                      S
                                     WK
                                     CVV
                                     ID
                                     A/0
                                       Ave.
                            BLOCK SUMMARY
                                                                 L_
                                                      4-1 1
          CM
          10
                                                              f.
                                                            i    r
Residential

c
^
ll
1/1 K
(0

tt
U
, Doulitc
Reside
/
*«
" S
•§" 5
i.l
N
/
U
>-

«
'ij
,0
N

U


€
"3
o
I
N

U




II




31 ~
a o
O >-i
/
S.
£'

OUicr-
Indicat




a
(2
9
Non-Residential


v> U
S 1
lo


c
S &
o ^
a .0
ca ^:



u* °
ll
y t-i
5 O

u
•a
'-Pr
ys
ll



tja
Office
Bulldin




_o £"
2 S



o
s

•a

7!
U
S 3
a. <


V
-3
> S

?i
^






|




O
|.
/

II
3

lg

Physlcil Condition
Number of Structures


1
z


_M
O oi
-f


Minor
Repairs
3

u
Extensi*
Repairs
/

•&
0)
TJ
"S.
rt
a
a



Vacant
/
Sanitary Condition



? &
^ i<:
6


•o to
u c
Dllopida
Oucbulld
£

«

ll
-3o
^
Number of Premises

5
s
&5
II
/

a
Rix'.unt
Marhora
/


Standing
Water
/


ScpUc
Overflow



te 2
0 ft
a u
/


Clilckcna
/


Horbes



K»
*
o
U
/

£
Air polJu
fi« HI re us

i
s.
Oiher Ob
tlonable

Water Sources

II
/

6
ll
/

r Municipal
Simply
B

0 
-------
5. CURRENT STATUS OF HEALTH (HEALTH INDEX SURVEY)

     Few communities will need to do a complete health survey.

You may, however, wish to conduct a community needs survey or de-

termine how aware the residents are of the health services avail-

able to them.  In some communities, it may be desirable to find

out where people go for health services and what type of health

delivery systems they prefer.  Where specific problems exist, such

as disease outbreak or deficiencies in public health services,

you may want to determine the extent of the problem and what is

being done about it.

     The survey forms and procedures outlined in this section were

designed to be used selectively.  You can choose those portions

that are applicable to your purpose.  You should discuss your needs

with the health planners and decide what procedures would be best

for your use.

     The procedures outlined were devised for the particular pur-

pose of evaluating health effects associated with energy develop-

ments, although they are applicable to general appraisal of health

status.  The survey was designed to secure the following type of

information:

         Need and adequacy of health and sanitation services in
         the community.

         Environmental conditions that affect health.

         Extent of protection against diseases preventable by
         immunizations.

         Current and previous experience with diseases and injury.

         Sources of health services.
                              -56-

-------
Type of Survey
     Information is obtained by a personal interview with  an  in-
formed respondent, preferably the housewife, in each household  from
which information will be obtained.  The interview should  be  con-
ducted by a person specifically trained for the purpose.   Current
employees of health agencies, persons with experience in conducting
interviews on other subjects, and interested volunteers are some
of the candidates for training.   The material provided here may be
used for orientation and training interviewers.

Seclection of Families for Interview
     The information is obtained from an entire family or house-
hold unit. (A household unit is  all persons residing permanently
in a dwelling unit.)  Members of the household may reside in  a
single-family dwelling or occupy one of several units in an apart-
ment house.  In any event, the information obtained relates to
only the persons that comprise the family or household unit.
     Information is desirable from all families in communities
consisting of about 200 families or less.   In larger communities,
the resources and time available may necessitate sampling only a
portion of the community.   There are several procedures that may
be used to identify a representative sample of respondents in the
community.   One that has proved  useful in health surveys is "Attri-
bute Sampling Methods for  Local  Health Departments", Public Health
Services Publication No.  1230, available from the Government Print-
ing Office.
     Since  the primary concerns  here are health  effects  in rapidly
                              -57-

-------
growing communities, the health index survey may be confined to

the recently developed portion of the community if absolutely ne-

cessary.  This is, however, a poor alternative as the entire com-

munity is involved and only the extent of impact varies among

different sections.  Generally, the sample should be as large as

circumstances permit -- preferably the entire community if 200 or

fewer families are involved.



Arrangement of the Interview Form

     The forms used for the Health Index Survey are illustrated in

Figures 5-1, which consists of Pages 1 through 16.  The series of

form shown on Pages 1 through 14 is arranged for use on a clip-

board to facilitate handling of the forms during the interview.

         Page 1 of Figure 5-1 provides for recording data that iden-
         tifies the community, neighborhood, household, and inter-
         viewer.   The data and time the survey was conducted, or
         attempted, and other data also are recorded on Page 1.

         Page 2 was designed to obtain impressions about the needs
         for health services in the community and the respondent's
         evaluation of the adequacy of existing efforts.

         Page 3 is arranged to determine the extent to which se-
         lected health and welfare services available in the com-
         munity are used by the household members and which pre-
         sently unavailable services would be used if they were
         accessible.

         Page 4 concerns the impressions about environmental con-
         ditions  and community services that affect health.

         Page 5 provides for information on the protection that
         the family members have against diseases that are pre-
         ventable by immunization, the tests they have had for cer-
         tain diseases, and physical examinations they have had.

         Pages 6, 7, and 8 concern the family's experience with
         illness  and injury.

         Pages 9  and 10 concern the sources of regular medical care
                              -58-

-------
         and places and reasons  for health care in institutions.

         Pages 11 and 12 relates to information concerning habits
         and behavior that affect health of family members.

         Page 13 contains provisions for listing the names and ages
         of household members and recording other information about
         the family and the place of residence.

         Page 14 is for recording information regarding deaths of
         immediate family members.

         Page 15 and 16 are a separate list of questions relates
         to mental health.  This is left with the respondent to
         complete after the interview and then mail to the inter-
         viewer or the organization conducting the survey.

Pages 1, 2, 3, 4, 13, and 14 are eight and one-half by fourteen

inches and the remainder are eight and one-half by eleven inches.

Any other convenient proportionate sizes can be used provided the

names of household members listed on the roster on Page 13 is vis-

ible and properly aligned when overlain by Pages 5 through 12.  The

pages of the survey forms are stapled on the right hand margin.
Suggestions for Conducting the Interview

     A brief explanatory statement should be prepared for use by

interviewers in each community.   This should contain an explanation

of the local sponsorship of the survey and its purpose.  It should

give a brief overview of what information will be requested.  The

respondents should be assured that all responses are confidential

and that individuals and premises will not be identified in reports

or otherwise.  It should be emphasized that the survey is designed

to gather statistical data that will be used to improve and deve-

lop health services for the community.

     Page 1.  Identification Data and Schedule of Interview.  The

identification data should be recorded on Page 1 of each series of


                              -59-

-------
                       Figure 5-1

                  HEALTH INDEX SURVEY

Investigations of Health Effects Associated with Energy Development
Record of Call Attempts
Date
1.
2.
3.
4.

Time
Began Ended
AM AM
PM PM
Tirne
AM
PM
AM
PM
AM
PM
AM
PM
Comments




Record of Interview
Date Completed Comments



Non- Interview Reason
1 Vacant 4 Other ( SPECIFY)
2 Not at home
3 Refused



Identification No.

Interviewer	

C ommunity	
Office Use
   Only
                                                                         Sample Number

                                                                         Neighborhood	

                                                                         Household
                                                        Page 1
                                                            -60-

-------
                           RESPONDENT'S GENERAL IMPRESSIONS OF HEALTH AND SANITATION SERVICES
Health Services
            Some health services that are available in one town may not
            be available in another town, have you or anyone in your
            household ever  needed a health service that was not available
            in this community?      1   Yes (If yes)  What type of service was needed?
                                   2   No
Are you satisfied with the variety of health services
provided in this community at the present time or do
you feel additional services are needed?
  1  Satisfied now
  2  Need additional services (Ask G)
         G.  What do you consider to be the most urgent needs for additional health services in this community?
            a.                                  "                          b.
            c.
Sanitation Services
What do you think could be done to make the
entire community a more healthy and attractive
place to live?
a.
b.
c.
d.
What do you think could be done to make your
own neighborhood a more healthy and attractive
place to live?
a.
b.
c.
d.
Who, if anyone, is doing
anything about the communi-
ty needs at the present time?




Who, if anyone, is doing any-
thing about your neighborhood
needs at the present time?




Do you think they are doing
enough, or could additional
work be done?(CIRCLE NO.)
1. Doing enough now
2. Could do more
1 . Doing enough now
2. Could do more
1 . Doing enough now
2. Could do more
1 . Doing enough now
2. Could do more
Do you think they are doing
enough, or could additional
work be done?(CIRCLE NO.)
1 . Doing enough now
2. Could do more
1 . Doing enough now
2. Could do more
1 . Doing enough now
2. Gould do more
1 . Doing enough now
2. Gould do more
What else should be done, who should
do it?




What else should be done, who should
do it?




                                                       Page 2
                                                                      -61-

-------
ANSWER CODES FOR USE ON PAGE 3
Reasons for Not Using Service




(1) Did not know about service




(2) Not needed




(3) Not convenient




(4) Did not like the service provided




(5) Other
                                             -62-

-------
                                     AWARENESS AND USE OF COMMUNITY HEALTH SERVICES



(Interviewer: Before the intervieiv, check which services are actually available in the community.)

A.  Which of the following health services do you know are available in this community?  (READ ENTIRE LIST)

B.  Which of the following health services in this community have ever been used by members of your family or other
    residents in your home?  (READ AVAILABLE LIST)

C.  Which of the following health services would your family or other  residents in your home use now if they were
    available? (READ UNAVAILABLE LIST)
Available















Type of Health Service
Immunization clinic
Prenatal clinic
Well-child clinic
Nutrition counseling service
Family planning service
Tuberculosis clinic
Venereal disease clinic
Mental health center
Cancer detection clinic
Program for physically handicapped
Alcoholics anonymous (or similar program)
Drug abuse
School lunch program
Programs for the elderly
Welfare services
A
Yes















No















Don't
Know















B
Yes















No
(Code)















Don't
Know















C
Yes















No
(Code)















Don't
Know















                                                                          -63

-------
                          IMPRESSIONS ABOUT ENVIRONMENTAL CONDITIONS AND COMMUNITY SERVICES THAT AFFECT HEALTH
A.  Indoor Conditions

   Have you noticed or been bothered by any of the following things in or near
   your home in the past 12 months?

Mosquitoes
Flies
Cockroaches
Other Insects (SPECIFY)


Mice
Rats
Other (SPECIFY)


Yes











No











Do not know or have not been botherec











B. Community Services

   How would you rate the following community services,
   would you say	was satisfactory or unsatisfactory?
Type of Service
Trash collection
Garbage collection
Street lighting
Street maintenance
Police protection
Fire protection
Public transportation
Are there any other services
that you would like to com-
ment about?


Satisfactory











Unsatisfactory











No Opinion











      For the remaining questions I need to know the names of all the family members.  (Also the names of other persons living In the household who are
      not members of the family.)
                                                                              -64-

-------
ANSWER CODES FOR USE ON PAGE 5
              M-M-R

              (1)  Measles single
              (2)  Rubella single
              (3)  Mumps single
              (4)  M-R (measles-rubella)
              (5)  M-M-R (mumps-measles-rubella)
              ( 6)  Do not know
Place of Service

(1) Private physician's office
(2) Health Department
(3) School
(4) Hospital
(5) Military
(6) X-Rav Mobile Van
(7) Other
                                                         -65-

-------
                                 IMMUNIZATIONS, TESTS, PHYSICAL EXAMINATIONS




Has (READ NAME) been (Immunized for _  _, Tested for	_,  Had a Chest X-Ray or Physical Examination) ?
Polio Vaccine
fNo. of doses)
&M_










njection









1
DPT
(Date)










TD or T
(Date)










M-M-R Vaccine
(Code)










(Date)










Other
Type Year








Source
of
Immuni-
zation
(Code)








T.B. Skin Test
(Date)








1 I
] " T 	 s
— ,
Results








Source
(Code)







i
— — jr—
Chest X-Ray
(Date) (Code)








1
- I
	 1 , ,.!.„_ 	
Physical Exam

Nevei










Date
of
Last





<<&




-»
SOL
(C<










                                                            Page 5

-------
ANSWER CODES FOR USE ON PAGE 6
       Frequent or Recurrent Problems

       (1)  Upper Respiratory Infection
       (2)  Pneumonia
       (3)  Cough
       (4)  Sore Throat
       (5)  Asthma or Allergy
       (6)  Diarrhea
       (7)  Stomach Ulcers
       (8)  Headaches
       (9)  Eye Irritation
      (10)  Ear Infections
      (11)  Fever Blisters
      (12)  Skin Rash
      (13)  Painful or Swollen Joints
      (14)  Kidney/Bladder Infections
      (15)  Dental Conditions
      (16)  Nervous or Emotional Problems
      (17)  Other Health Problems (not defined)
Handicaps

(1)  Birth Deformities
(2)  Cerebral Palsy
(3)  Hearing Trouble
(4)  Missing fingers/arm
(5)  Missing toes/leg
(6)  Paralysis
(7)  Permanent Stiffness
(8)  Seeing Pi oblems
(9)  Speech Trouble
                                                           -67-

-------
Does
 FREQUENT OR RECURRENT PROBLEMS AND HANDICAPS




any frequent or recurring health problems or handicaps?

Code










FREQUENT OR
Number ofJEjDisodes
__Da^__









Week








J_«_
Year








•
1 ...J
RECURRENT PROBLEMS
Year of
Onset







'
1
!
	
Code







i
1 f
|
t
(
- — j
^ifflt1 bJsT-P f^&SU ? odes
Day 1 Week






!







1
B
i
" •

\
[Year









Year of
Onset





..
HANDICAPS i
Code





L______

n 	
Fj
T
1

Year of
Onset








Code






t,

Year of
Onset








i *
i I

__, 1
                       Page 6
                                         -68-

-------
ANSWER CODES FOR USE ON PAGE 7
    Previous Diseases

    (1)  Mumps
    (2)  Measles
    (3)  Rubella
    (4)  Whooping Cough
    (5)  Other
 Chronic Conditions

 (6) Chronic cough
 (7) Chest pain
 (8) Shortness of breath
 (9) Emphysema
-(10) Asthma
(11) Bronchitis
(12) Tuberculosis

(13) Sinus Trouble
(14) Allergy (any)
(15) Skin Trouble

(16) Anemia
(17) High Blood Pressure
(18) Stroke
(19) Hardening of the arteries
(20) Heart Trouble
(21) Rheumatic Fever

( 22) Stomach Trouble
(23) Stomach Ulcer
(24) Gallbladder/Liver Trouble
(2o) Hepatitis (Jaundice)
( 26)  Kidney Stones
(27)  Prostate Trouble

(28)  Hemorrhoids (Piles)
(29)  Varicose Veins

(30)  Thyroid Trouble
(31)  Diabetes

(32)  Arthritis/Rheumatism
(33)  Back Trouble

(34)  Convulsions (Epilepsy)
(35)  Nervous Conditions

(36)  Hernia
(37)  Tumor or Cancer

(38) Other	
                                                          -69-

-------
                                 PREVIOUS DISEASES AND CHRONIC CONDITIONS
What chronic or acute disesase has (NAME) had? In what year was the onset of that disease?
Code











Year of
Onset










Code










Year of
Onset










Code










Year of
Onset











Code










Year of
Onset










Code










Year of
Onset










-7fU
Code











Year of
Onset












-------
ANSWER CODES FOR USE ON PAGE 8
            Place of Accident

            (1) At home or adjacent premises
            (2) Street and highway
            (3) Farm
            (4) Industry
            (5) School
            (6) Place of recreation and sports (except school)
            (7) Other, including business, church, progessional office,  etc.
                                                                     -71-

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                          ILLNESS WITHIN PREVIOUS TWO WEEKS OR INJURY WITHIN PREVIOUS YEAR




Has (NAME) been ill in the past 2 weeks or been injured in the past 12 months?
Illness Name










Injury
Name










Accident
Place (Code)











Duration










Physician Consulted
Yes










No










Name










Hospitalized
Yes










No










Where










How Loi










                                                                    -77._

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ANSWER CODES FOR USE ON PAGE 9
    Reason for Physician Visit

    (1)  Diagnosis or Treatment
    (2)  Pre or Post-Natal Care
    (3)  General Check-Up
    ( 4)  Immunization or Vaccination
    (5)  Eye Examination (glasses)
    (6)  Other
Reason for Dentist Visit

(1)  Fillings
(2)  Extractions or other surgery
(3)  Straightening (Orthodontia)
(4)  Treatment of gums
( 5)  Cleaning teeth
(6)  Examination
(7)  Denture work
(8)  Other
    Location of Physician and Dentist

    (1) Local private physician or dentist
    (2) Private physician or dentist in another County
    (3) Private physician or dentist out of state
    (4) Military Medical Care
    (5) V.A. Medical Care
                                                                   -73-

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                                         SOURCES OF RECENT MEDICAL CARE
Has (NAME) been to either a physician or a dentist in the past 12 months?
VISIT TO PHYSICIAN VISIT TO DENTIST
How Many Times










Date of Latest










Reason for Latest
(Code)










Where
(Code)










How Many Times










Date of Latest










Reason for Latest
(Code)










Where
(Code;











-------
ANSWER CODES FOR USE ON PAGE 10
            Type of Facility                                    Outcome

            (1) Local Hospital                                 (1) Recovered
            (2) V.A. Hospital                                  (2) Improved
            (3) Convalescent Hospital                           (3) No change
            (4) Nursing Home                                  (4) Worsened
            (5) State Tuberculosis Sanatorium
            (6) State Hospital
            (7) Institution for Exceptional Children
            (8) Other health related facility
                                                                     -75-

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                                    STAY IN HOSPITAL OR INSTITUTION IN THE PAST YEAR




Has (NAME) ever been a patient in a hospital or other health related institution within the past year?

Never












Number of
Times










1
Type of
Facilities
(Code)










Reason










Length of Stay










Outcome
(Code)










2
Type of
Facilities
(Code)










Reason










Length of Stay










Outcome
(Code)










                                                                                  -76-

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COPIES OF CARDS TO BE HANDED TO RESPONDENTS
Diet
(1)
(2)
(3)
(4)
(5)
(6)

(7)
Has a proper
diet
Particular about
Has frequent
eating, and does not eat properly
snacks between meals
Frequently eats
Drinks about

candy

soft drinks a day
Is on a diet prescribed by
because of
Other:














                                    Smoking

                                    (1)  Never has smoked
                                    (2)  Smokes     packs of cigarettes a day
                                    (3)  Smokes a pipe or cigars
                                    (4)  Formerly smoked, but stopped	months ago
                                    (5)  Other	
                                  -77-

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HABITS AND BEHAVIOR THAT AFFECT HEALTH

1










DIET: The statement on this card can be used to describe
a person's eating habits . Which of these
apply to (NAME) ? (Code as many as apply.)
2










3










4










5










6




















7











SMOKING: This card describes various smoking
habits . Which of these apply
to (NAME) ? (Code as many as apply.
1










2










3










4










5




















                                  -78-

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                                COPIES OF CARDS TO BE HANDED TO RESPONDENTS
Hazards (indicate at Home,  School, or Work)

(1)  Not exposed to unusual hazards
(2)  Operates dangerous equipment at:(Home) (School) (Work)
( 3) Building at (Home) (School) (Work)

    is not safe because (Specify)	
(4) Other hazards at (Home) (School) (Work)
            are
                                             -79-
Indoor Environment (indicate at Home,  School, Work)

(1) No adverse conditions
( 2) Objectionable noise at (Home) ( School) ( Work)
                                                            (3)  Poor lighting at (Home) (School) (Work)
(4) Object, onable odors at ( Home) (School) (Work)
                                                            (5)  Objectionable dust at (Home) (School) (Work)
(6) Eye irritation experienced at( Home) (School) (Work)
                                                            (7) Difficult breathing experienced at (H) (S) (W)
                                                            (8) Other objectionable conditions at (H)  (S) (W)
                                                                are

-------
HAZARDS: This card describes the types of
           hazards that face some people.
           Which of these would apply to
           (NAME)  and please complete
           the description.  (Code as
           many as apply.)
INDOOR ENVIRONMENT:
This card describes the various types of
indoor conditions that face some people
Which of these would apply to (NAME) ?
(Code as many as apply.)
1










2
H S W









3
H S W









4




















1











2
H S W









3
H S W









4
H S W









5
H S W









6
H S W









7
H S W









8
H S W



















                                                             Page  12
                             -80-

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     ANSWER CODES FOR USE ON PAGE 13
      (A) Ethnic Group

          (1) Caucasian
          (2) Spanish-American
          (3) Black
          (4) Indian
          (5) Oriental
          (6) Other:
                               (B) Type of Dwelling Unit

                                  (1) Separate house
                                  (2) Duplex
                                  (3) Single cottage apartment
                                      or garage apartment
                                  (4) Apartment in multiple
                                      unit structure
          ( 5)  Mobile home
          (6)  Trailer
          (7)  Motor home
          (8)  Tent
          (9)  Other:	
(C)  Apparent Condition of Dwell in
     Unit

     (1)  New (occupied less man
         1 year)
     (2)  Good condition
     (3)  Needs minor repairs
         (paint, clean-up, etc.)
     (4)  Needs extensive repairs
         (reroofing,  broken brick
          work^ broken windows,
          holes in walls)
(D) Type of Heating in Home

    (1)  Central, warm air
    ( 2)  Steam or Hot Water
    (3)  Built-in electric (ceiling wall
         or baseboard)
    (4)  Floor or wall pipeless furnace
    (5)  Fireplace, stove,  or portable
         room heater
    (6)  Other:	
    (7)  None
                                (E)  Type of Cooling in Home

                                    (1)  Part of central heating system
                                    ( 2)  Separate central air conditioning
                                    (3)  Portable room air conditioning
                                    (4)  Other:	
                                    (5)  None
                   (F) Sewage Facilities   (G)  Water Facilities
                       (1)  City sewer
                       ( 2)  Septic tank
                       (3)  Cess pool
                       (4)  Privy
                       (5)  Unknown
          (1)  Municipal (City)
          (2)  Private water com{
          (3)  Private source
          (4)  Dug well
          (5)  Cistern
   (H) Solid Waste Disposal

       (1) Municipal collection
       (2) Contract with private company
       (3) Resident transport to disposal site
           Where:
           Disposal on premises:
           Burn    Bury	Other
(4)

(5) Other:
(I) Education of Household Head

   (1)  Postgraduate Work
   (2)  College Graduate
   (3)  College 1-3 Years
   (4)  High School Graduate
   (5)  10-11  Years
   (6)  7-9 Years
   (7)  0-6 Years
   (8)  Unknown
      -81-

-------
Name
First Middle Last*
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Age










Sex
M










F










Relationship
to Head of
Household











                                                                 Family Name

                                                                 Address
                                                                 Phone No.
                                                                 Ethnic Group (observe)
                           Code |     j  (A)
                                                                 Residence:
                                                                 Length of time in this community:
                                      years,
                                                                 Anticipated length of stay in this community:  indefinitely
                                                                 Length of time in this residence:
                     months
                          or for
                                    years,
                                                 months
                                                                 Dwelling Unit:
                                                                 Type of dwelling unit
                                                                 Number of rooms
                        Code j     | (B)
                       Number of rooms used only for bedrooms_
Apparent condition of dwelling unit     Code f~    i
Type of space heating    Code I     J (D)
Type of space cooling    Code )     | (E)
                                                                                                                  (C)
                                                                 Sanitary Facilities:
                                                                 Type of sewage facilities
                                                                 Type of water facilities
                                                                 Type of solid waste disposal
                            Code!     j(F)
                            Code |    ](G)
                            Code |     |(H)
                                                                  Jog
                                                                 Number	
                                                                 Number vaccinated against rabies:	

                                                                 Employment:
                                                                 Education of Household head      Code]
                                                                 Occupation of household head:_
                                                                 Where employed:	
                                                                 Respondent: Household Head
                               Spouse
          Mature Child
           (18 or over)
Other (Specify)
 (18 or over)
*Last name only if different from family name.
             Page 13
-82-

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DEATHS OF MEMBERS OF IMMEDIATE FAMILY (INCLUDING STILLBIRTHS)
Sex










Date of Death










Age at Death










Relation to Head
of Household










Place of
Death










Place of Residence
State










County










Cause of Death










                           Page 14






                           -83-

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                                                                      15
                  THE MENTAL HEALTH QUESTIONNAIRE
You have given us a good deal of important general health information which the
Health Department will find very helpful in their work of protecting the community's
health.  In addition, health is often related to how people live and the kind of problems
they face . In order to know whether services  should be provided to help out with these
problems, and if so where, and how much, and what kinds of service, we must first
have some information about the problems . Please  answer the following questions,
and feel free to ask the interviewer about any you don't understand .

Please do not sign this paper unless you want to.  Place  the paper in  the pro-
vided envelope, seal the  envelope and put it  in the mail.   Nobody
will know what answers you gave to  these questions because this
paper is  not  identified  irt any way.
Check the line that you think best answers the question .
                Don't
 Yes     No    Know
                        Has anyone in the household retired in the past two years,
                        or will they in the next year ?
                        How many?	

                        Are there any serious problems with raising the children?
                        How many "problem children"?	

                        Have any of the children dropped out of school in the past
                        tv/o years ?
                        How many children dropped out?	

                        Have any of the children been in trouble with the law
                        (juvenile court)?
                        How many have been?	

                        Has anyone else in the household been in trouble with the
                        law (convicted) in the past two years?
                        How many?	

                        Do any members of the household drink excessively?
                        How many do?	

                        Has there been a divorce in the past two years ?

                        Has there been one  or more separations of the parents?

                        Do they ever threaten or discuss divorce or separation?
                                     -84-

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                                                                       16
                Don't
 Yes     No     Know

                        Does any family member show behavior problems, such as
                        using drugs, getting in trouble or being delinquent,  running
                        away from home or school, or being too agressive (fighting,
	   	   	   beating wife or children, etc .) ?
                        How many  such members ?	

                	   Are there serious problems in the marriage ?

                        Has any member of the household had psychiatric treatment
	   	   	   or help for nervous or mental trouble in the past two years?
                        How many have?  _ 	

                        Has anyone from this household been admitted to a mental
        	   	   hospital in the past two years ?
                        How many?	

	   	   	   Are there any mentally retarded members of the household?
                        How many?	

                        Has anyone from the home been admitted to a home for
	   	   	   retarded children?.
                        How many?	

                        Does anybody in the family wish for help - or wish that another
                        family member would get help - for nervous or emotional
	   	   	   trouble, worries, or for the way he acts sometimes?
                        How many  should get help?	

	   		   Is the family on welfare?

_____   	      _.     Does the family get any other kind of financial assistance?

	   	   	   Is the head of the family unemployed?
                        For how long?	

                        Is anyone else in the household unemployed, who is  of age
	   and really  should be working?
                        How many?	

Please name the two greatest problems  for you,  or the family as a whole, or for other
family members; those problem which you would most like to get taken care of.
1.

2.
Thank you very much for your help.

                                      -85-

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Health Index Survey forms before the forms are taken in the field



to conduct interviews.  A record should be made of each attempt to



conduct an interview and the ultimate outcome of these efforts



should be recorded.



     Page 2.  Informant's General Impressions of Health and Sanita-



tion Services.  The information requested on Page 2 of the Health



Index Survey form is designed to obtain the informant's own impres-



sion about health and sanitation services in the community without



specific or leading questions from the interviewer.  The questions



on Page 2 should be asked exactly as written but in a conversational



manner rather than as a list of interrogations.  The introduction



and explanation can be continued to pose these questions but dis-



cussion of problems or conditions in the community prior to begin-



ning the interview is not desirable.  The interviewer should be



completely neutral with regard to problems and conditions and nei-



ther agree or disagree about them.  The respondent should not be



able to anticipate the answers that the interviewer may expect.



     Page 3. Awareness and Use of Community Health Services.  The



information from the questions on Page 3 will indicate the respon-



dent's awareness of need and availability of some important health



and social services in the community and whether or not the family



uses them.  Names of additional services may be added to this list



as appropriate for specific communities.



     Before undertaking the survey, it should be determined which



of the services listed are available in the community.  A check



should be made in the "Available" column indicating these.



     In conducting the interview, the respondent should be asked
                               -86-

-------
which of the entire list of services is known to be available.  The
entire list of services should be read without reference to the
interviewer's knowledge of their availability.  The respondent's an-
swers should be recorded by placing a check in the appropriate
column in area "A" of the form.
     The respondent then should be asked which of the available
services are used by any household member.  The list of services
identified by checks in the "Available" column should be read and
the respondent's answer recorded for each in the "B" area of the
form.  If a "no" answer is given, inquiry should be made to deter-
mine why the service is not used.  The response given should be
recorded in the "No" column using the appropriate number from the
code.
     The respondent then should be asked whether or not the ser-
vices on the list which are not presently provided in the community
would be used if they were available.  Read the entire list of
services that were not previously checked as being available.   Re-
cord the responses in the "C" area of the form.  If a "no" answer
is given, ask why the services would not be used.  The response
should be recorded in the "No" column using the appropriate code,
     Page 4. Information About Indoor and Outdoor Environmental
Conditions and Community Services That Affect Health.  Information
from the questions on Page 4 will give the informant's impression
about selected environmental conditions and community services.  The
"A" list concerns nuisances that may occur in or near the dwelling
unit.  The "B" list concerns community services related to health
and safety.  Each one of the itmes should be mentioned separately
                              -87-

-------
and the answer recorded.  After inquiring about the items on each



list, the respondent should be given the opportunity to identify



and comment about any other conditions or services.  (After com-



pleting Page 4, the interviewer should tell the respondent that



the interviewer will need to ask questions concerning individual



members of the household.  The interviewer should  turn to Page 13



and ask the respondent to give the names of each member of house-



hold.  Names of only those persons regarded as members of the "fa-



mily" should be recorded,  Names of either relatives or non-relatives,



that are so regarded, should be listed but renters or boarders



should not be.  The family name, address, and phone number should



first be obtained and recorded.  The names, age, sex, and relation-



ship of the individual household members then should be obtained



and recorded.  The first listed should be the head of the house-



hold, then the spouse, the children in order of age -- the oldest



first, then relatives or other members.  The remaining information



on Page 13 should not be obtained until Page 12 is completed.)



     Page 5. Immunizations, Tests^JPhysical Examinations.  Know-



ledge of the number of persons protected against diseases prevent-



able by immunization is useful for two primary purposes;   (1) it



provides an indication of the extent to which the  entire population



is protected against certain diseases, and (2) it  is an indication



of the availability and efficiency of health services in the com-



munity.



     Except for the column for recording "TD or T" and "other", in-



formation should be obtained only for children under ten years of



age.  Usually the most reliable information on immunization is ob-






                              -88-

-------
tained from the mother.   The interviewer should ask if she has

records on immunization of the children and if she would get the

data from them.  If records are not available, the respondent should

be asked to try to recall the year of each immunization for each

child.  Information in each column should be asked for specifically.

         Polio vaccine - Only the date of the most recent immuni-
         nation should be recorded.  Children usually receive oral
         polio vaccine.   Immunization records may indicate "OTPV"
         (oral trivalent polio vaccine).   If the type of vaccine is
         not recalled, the respondent should be asked if drops were
         placed in the child's mouth or on a sugar cube which was
         given to the child.  If the answer is affirmative, the im-
         munization should be recorded under "Oral."  If the type
         cannot be determined, "?" should be recorded under "Oral."

         DPT - (diptheria, pertussis, tetanus) Often identified as
         "baby shots."  Only the year of the most recent immuniza-
         tion should be recorded.

         TD or T - (tetanus-diptheria or tetanus) "TD" may be writ-
         ten also as "DT."  Tetanus-diptheria usually is given to
         persons over five years of age.   Tetanus may be given
         following an injury in which the skin is broken.  Year of
         administration for both adults and children should be re-
         corded.

         Mumps, Measles, and Rubella - Vaccines for mumps, measles,
         and rubella may be given singly or in combination.  Appro-
         priate number from code should be used to identify single
         immuniation for mumps, measles,  and rubella or for combi-
         nations of immunization.  Measles is also called hard
         measles, 10-day measles, red measles, and rubeola.  Rubel-
         la is also called German measles and 3-day measles.  If
         "measles shots" are reported for a child, but the respon-
         dent doesn't know whether or not other immunizations were
         given in combination, this should be recorded as "(1)
         measles single."

         Other - This column may be omitted except for special pur-
         poses, for example, a local epidemic for which immuniza-
         tion is available.  However, the information should be
         recorded if the respondent volunteers it.  There are only
         two principal "other" kinds:  yellow fever and cholera.
         Persons who have traveled abroad may have received one or
         both.  Smallpox should not be recorded since this immuni-
         zation is no longer required or recommended in the United
         States.
                             -89-

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         Source of Immunization - The place where immunization was
         received should be recorded by entering the appropriate
         number from the code.

         T.B. Skin Test - Information concerning skin test for tu-
         berculosTis, and chest x-ray in the next column, is needed
         to determine the extent to which the population has been
         exposed to tuberculosis.  This information should be ob-
         tained for each member of the family.  Results of skin test
         should be recorded as "pos" or "neg", "+" or "-" should
         not be used.  If any family members are receiving medica-
         tion because of a positive skin test, "M" also should be
         entered under "results."  Source of the test should be
         indicated by entering the appropriate number from the code.

         Chest^X-Ray - A chest x-ray usually is made if the skin
         test is positive, and also may be made for other reasons.
         For example, many hospitals routinely make a chest x-ray
         on admission.  Information for each family member that
         had a chest x-ray should be recorded using the code to
         indicate the place where x-ray was made.

         Physical Examination - This information is needed to de-
         termine the proportion of the population that had a recent
         physical examination.  Data should be recorded for each
         family member using the code to indicate where the exa-
         mination was made.

     Page 6.  Frequent or Recurrent Problems or Handicaps.  The in-

formation supplied on Page 6 indicates the experience of the family

with respect to frequent or recurrent illnesses and handicaps.

These data are helpful in determining what problems developed or

occurred in the current place of residence and the experience of

the family in other localities.

     The respondent should be shown the list of frequent or recur-

ring illnesses and asked about the family's experience with them.

Each disease or condition should be mentioned individually.  (This

information indicates other health conditions of the family and the

frequency of occurrence.   The year of onset indicates whether or not

the condition developed recently or is long-standing.)  The code
                              -90-

-------
should be used to indicate the condition(s) identified by the res-
pondent for each family member.
     The respondent should then be asked how frequently the condi-
tion occurs.  This might be reported as about twice a day, three
times a week, or twice a year.  The number given should be entered
in the appropriate column under "Number of Episodes,"  The columns
are ruled for recording two conditions for each household member,
however, space is adequate for making additional entries if neces-
sary.
     The respondent should then be asked the year when the problem
started and this should be entered under "Year of Onset,"
     For example, a report that a person has had a headache twice
a day for the past year should be entered on the proper line for
that family member as follows:  5 in the "(code)" column, 2 in the
"Day" column, and 1975 in the "Year of Onset" column.
     Page 7. Previous Diseases and Chronic Conditions.   The infor-
mation secured from answers to questions on Page 7 augments that
which is on Page 5 and aids in evaluating the levels of immuniza-
tions in the community and availability of public health services,
     The respondent should be shown the list of "Previous Diseases"
and asked which household members have had any of those listed.
Each disease should be mentioned individually.  Any "other" reported
should be recorded as "(5)" opposite the name of the proper person.
The "other" should be identified under (5) in the list of "Previous
Diseases" specified in the code.  If "other" is reported for more
than one household member, the members' numbers should be noted by
the condition added under (5) in the code.  For example, family

                              -91-

-------
member number 4 was reported to have had poliomyelitis and family



member number 5 was reported to have had encenhalitis.   An



entry of "5" should be made in the appropriate column for each mem-



ber.  Notations in the code should indicate:  4 - poliomyelitis,



5 - encephalitis.  Information about "measles" should distinguish



"measles" from "rubella" by entering an "M" or "R" in the "measles"



column.  The condition should be indicated by entering the appro-



priate number from the codes in the proper columns.  The respon-



dent should next be shown the list of chronic conditions.  Each



should be named individually, and inquiry made of experience of



each household member.  The code should be used to indicate condi-



tions experienced by the various family members and the year of



onset recorded in the appropriate columns.



     Page 8. Illness in the Fast Two Weeks or Injury in the Past



Year.  This information is useful in determining the current con-



ditions of health in the family and how medical services are ob«



tained when needed.



     The respondent should be asked what illnesses have been exper-



ienced by the individual family members within the past two weeks.



Each member should be mentioned by name.  For example,  ask, "Has



	(name) been ill during the last two weeks or injured



during the last year?"  If the answer is "yes" the respondent then



should be asked what the illness was and the information recorded



in the "Illness Name" column or the "Injury Name" column.  The



respondent then should be asked whether or not a physician was



consulted, if so, the physician's name should be asked,  Inquiry



also should be made about hospitalization, as indicated on Page 8,





                              -92-

-------
and record the information in the "Hospitalized" column.  The res-



pondent also should be asked where the injury occurred and the  code



should be used to indicate the place in the "Accident Place" column.



     Any additional pertinent information volunteered by the in-



formant should be noted at the bottom of Page 8 or on the facing



code sheet.



     Information is sought only for the two previous weeks since



experience has shown that minor illnesses that occurred before  this



time frequently are forgotten.  If the informants tell you about



an earlier illness or injury, make a note of this at the bottom



of the page or on facing page but do not specifically ask about



earlier illnesses or injuries.



     Page 9. Sources of Regular Medical Care,  The information  on



Page 9 is needed to determine the frequency with which medical  and



dental services are sought, for what reasons, and where these ser-



vices are obtained.  This information then is used to indicate what



additional provisions should be made for these services and where



they should be located.



     To obtain the information for the ''Frequency" columns,  the res-



pondent should be asked how many times within the last year each



family member visited a physician or dentist,  Each family member



should be mentioned by name.   The number reported should be recorded



in the "How Many Times" column.



     The respondent should then be asked the date of the most re-



cent visit of each family member and the date reported should be



recorded in the "Date of Latest" column.   A list should not  be



displayed,  just the reason should be recorded as reported,






                              -93-

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     The location where the service was received should be entered



in the "where" column using the code for "Location of Physician



and Dentist."



     Page 10. Stay in Hospital or Institution in the Past Year.



The information obtained from the questions on Page 10 indicates



the frequency and purpose for use of selected health-related in-



stitutions .  Where combined with data from other sources,  for ex-



ample those obtained from Page 9, the information is useful in



planning the appropriate type and location of facilities to meet



the needs of the community.



     Information is recorded for each current member of the family.



Information should not be recorded for members who have died.



Inquiry should be made for each member by name and the number of



times during the past year that each person was in a health-related



institution should be recorded in the "Number of Times" column.



     The codes should be used to identify the type of facility,



the reason for admission, length of stay, and outcome.  The appro-



priate number should be recorded in the proper column.  Length of



stay should be recorded in days.  If a family member is a per-



manent occupant of an institution or a long-term occupancy is an-



ticipated, "L" should be entered in the "Length of Stay" column.



Space is provided for complete recording of two episodes.   If more



than two occurred during the year, complete data should be recorded



only for the two most recent ones.



     Page 11 and 12. Habits and Behavior.  The information obtained



by the questions on Page 11 and Page 12 relates to the possible



occurrence of health hazards and to some of the habits of family
                              -94-

-------
members that affect health.  All of these questions are concerned

with prevention of adverse health conditions.  This information

is requested near the end of the interview since by the time  this

point is reached, good rapport should be established between  the

respondent and the interviewer.

     Some of the questions pertain primarily to adults and others

to children.  The interviewer should mention the appropriate  family

members by name in each group as the card is displayed pertaining

to each set of questions.

         Diet - Pertains generally to all members, but specific
         inquiries should be made concerning children, especially
         consumption of candy and soft drinks.

         Smoking - Concerns teenage and adults.

         Hazards - Applies to everyone.  Specific inquiries should
         be made about schools and places of work.

         Indoor Enyironmen t - Also applies to everyone.   Specific
         inquiries should be made about schools  and places of work,

Conditions should be indicated in the proper columns by selecting

appropriate numbers from each of the corresponding codes.

     Space is provided on Page 11 and Page 12 for entering data

in the columns.  Note that some items in the codes o1" Page 11 and

Page 12 have blank spaces.  Appropriate data are to be recorded

in the columns on the forms.  If, on Page 11, an item in the  code

without a blank space is applicable, make a check mark in the col-

umn with the corresponding number.  If an item with a blank space

is applicable, enter the appropriate information in the column

corresponding with that number.  On completing  the forms on Page

12, circle H, S,  or W as appropriate and write  the information for

the blanks in the corresponding columns.


                              -95-

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     Page 13. Family and Environmental Information.  Page 13 per-



tains to condition of the residence where the family lives and to



general information about the family.  (Information concerning the



household roster was provided following description of Page 4.)



Since planning for health and environmental services requires data



on the number of people that will use them, it is necessary to



determine how many people are currently living in the community and



how long they plan to remain.  Answers to the questions about occu-



pation place of employment are helpful in this connection when the



respondent is not certain about the future plans for the family.



     Information concerning type and condition of the dwelling unit



is needed to anticipate the futre requirements for housing and



the necessity of repair and replacement.   Data pertaining to source



of domestic water, sewage disposal, and solid waste storage are



necessary to project needs for community environmental surveys.



     The interviewers should, in their own words, explain to the



respondent why the information requested by the questions on Page



13 is important for evaluating the health and sanitary conditions



of the community.



     In completing Page 13 information should first be obtained



concerning length of residence and anticipated length of stay in



the community.  The type of dwelling unit and the ethnic group



usually can be determined by observation.  Inquiry should be made



to determine the number of rooms in the dwelling and the number of



rooms used only as bedrooms.



     The remaining information should be obtained by direct ques-



tions to the respondent.  The appropriate number from the codes
                              -96-

-------
should be entered in the corresponding spaces.
     Page 14. Deaths of Immediate Family Members  (Including' Still-
births) .  Information concerning causes of death  is useful  in  char-
acterizing significant health problems of the population.
     The information requested for Page 14 is not related to the
household roster.  Names should not be entered on Page 14,  only
the information indicated in the column headings.
     The immediate family includes the spouses,  their children
(natural or adopted), and any other relatives who lived in  the same
dwelling with the current family members.
     If a stillbirth is reported "S" should be entered in the "Age
of Death" column.  If the cause of stillbirth is reported,  the
information should be indicated in "Cause  of Death" column.   For
example, "cord around neck," "mother had rubella," or "mother had
diabetes."  If the cause is not known, "UNK" should be recorded.
     If the age at death was less than one year, age should be in-
dicated in months in the "Age at Death" column.   For example, "5
months."

Mental Health Information
     The Mental Health Questionnaire (Figure 5-1,  Pages 15 and 16)
is designed to obtain information concerning stressful situations
that may affect the  health and social well-being of the family.
The questions are very personal and many people  are reluctant to
discuss  them with anyone.   Answers  to them are necessary,  however,
to plan  the types of health and social services  that will  meet
the needs of citizens  in the community.
                             -97-

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     The interviewer  should  carefully  explain  to the respondent the



importance of obtaining  the  information.  The  fact that no one



can identify the family  that provides  the data or the place where



they live should be emphasized.  Neither the questionnaire nor



the envelope provided is marked  in a way to enable anyone to know



the source of information.



     The interviewer  should  request the respondent to read the form



through and ask about any questions that are not clear.  An ad-



dressed, stamped envelope should be left with  the respondent to



return the completed  form by mail to the interviewing agency.







Filing Completed Survey Forms



     A filing system  should  be established for the orderly accumu-



lation and storage of completed  survey forms.  Individual folders



should be provided for each  block or neighborhood (or sector)



using the identification notations, if available, developed for the



environmental survey.  The exact method of filing will depend on



the sampling units employed.  As a general guideline, the system



used should permit consolidation of information as interviews are



completed in a defined geographic area, a block or neighborhood



for example.  The completed  forms should be filed each day.  When



the survey has been completed in an area, information should be



consolidated as described below.  The sets of  survey forms should



be numbered consecutively to provide control of the record,







Compilation and Analysis of Data



     The forms used for the Health Index Survey were so designed






                               -98-

-------
that the data collected could be consolidated by hand tabulation.



The arrangement of the forms does permit, however, easy adaptation



to mechanical handling if the necessary resources are available



and the volume of data warrant? machine processing.  In comtnuities



where the latter methods will be employed, the requisite special-



ists will be available for adapting the forms and processing pro-



cedures to the locally available system and equipment.  The sug-



gestions provided here anticipate hand tabulation and the use of a



conventional adding machine or office calculator.



     Consolidation of data should be done as surveys are completed



for previously defined areas.  Generally, this will be done for



each block and the resulting data aggregated for the neighborhoods



or sectors that were delineated in selecting the sample for sur-



veying.  Compilation of data by block provides flexibility in ag-



gregating information by various combinations of block according



to the homogeneity of the environmental and other variable to be



compared with health information.



     Before considering procedures for consolidation of data, at-



tention must be given to the form in which data are desired and the



means of extracting and transcribing them from the survey forms.







Transcription of Data



     Columnar analysis forms, available in pads from office supply



outlets, should be used to record data transcribed from the survey



forms.   This usually is done more efficiently by two people working



together,  one reading from the survey form and the other recording



on the analysis form.   Data from the survey form is recorded for
                               -99-

-------
each interview on the same horizontal line on each of  the analysis
forms.  The corresponding line on each of the analysis forms is
identified with the same identification number.  Entries of data
on the analysis form is made by a single vertical mark in the ap-
propriate column.  Data from the entire set of forms a household
interview should be recorded before work is commenced on another
set of forms.  When data from all interviews in a block are com-
pleted, the number of marks in each column is totaled and entered.
Information concerning each block is extended on a summary sheet
for the neighborhood or sector depending on how the means of ag-
gregation was planned,

Extracting Data from Survey Forms
     The survey forms were designed to secure data in detail for
individual factors, such as diseases and conditions,  rather than
for groups of factors.  In the initial extraction of data from the
survey forms, however, related factors often should be grouped.
This is determined by the relative frequency with which specific
diseases occur and the problems and needs of the community.   Before
designing the layout for data to be transcribed, the completed
survey forms should be reviewed to determine the specific items of
data and the extent of detail to be extracted,

Tabular Compilations
     Developing information from the data recorded on the survey
forms requires, first, preparation of a series of tables summariz-
ing the data and, second, analyses and interpretations of the data.
                              -100-

-------
Both provide the content for a report of findings from the survey.

The following are examples of the types of tables required:

         Characteristics of the survey sample

           - Distribution of the sample by neighborhood or sector,
             number and percent of blocks surveyed, number and per-
             cent of interviews completed.  (See Table 5-2.)

         Populations impression of health and sanitation services

           - Reported priorities of health and sanitation needs by
             neighborhood or sector.

           - Awareness and use of available public health services
             by neighborhood or sector.

         Extent of use of preventive health services

           - Number and percent of persons reported having a skin
             test for tuberculosis by neighborhood or sector, by
             age.

           - Number and percent of persons reporting a visit to a.
             physician or dentist by neighborhood or sector, by age

           - Number and percent of persons reporting immunization
             against communicable diseases by type of disease, by
             age, by neighborhood or sector.

         Experience with disease and injury

           - Number of recent illnesses reported by neighborhood
             or sector, by age.

           - Number of recent accidents reported by type of acci-
             dent, by place of occurrence, by age, by neighborhood
             or sector.

           - Number and type of frequent or recurrent health pro-
             blems by neighborhood or sector,  by age.

           - Number of reported respiratory diseases by neighbor-
             hood or sector, by type of disease, by occupation, by
             length of exposure.

Design of Tables

     The form of the Health Index Survey suggests some possible for-

mats for organization of tables.  Table 5-3 through Table 5-6
                              -101-

-------
indicate representative types suitable for presenting these data.

Selected reports from the accompanying list of references should

also be examined for ideas concerning forms of presentations,  as

should the vital statistics summary prepared by the state department

of health.

     After a preliminary decision is reached concerning the layout

of the tables, procedures for transcribing data from the Health
                            \
Index Survey form should be developed.  Obviously the table format

and procedures for transcription should be developed to accommodate

all data, for which a need can be foreseen, from the survey form

before transcription is begun.  In this way inconsistencies and

redundancies between the tables can be detected and adjusted.
                              -102-

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             Table 5-1
        Health Index Survey
           (Community)




Distribution of Population Interviewed
Sector or
Socioeconomic Areas
Established Areas
New Housing Areas
Mobile Home Areas
Temporary Housing Areas
All Areas




Number of Blocks
Total









Surveyed









Percent
of Blocks
Surveyed









Number of Interviews
Possible









Completed









Percent of
Interviews
Completed









                    -103-

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              Table 5-2
         Health Index Survey
            (Community)




Age Composition of Population Surveyed
Sector









Number of
Households









Number of Persons in Age Groups (Age in Years)
>1









1-4









5-14









15-24









25-39









40-64









65+









All ages









Persons per
Household









                      -104-

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                    Table 5-3
                Health Index Survey
                  (Community)




Proportion of Persons Under 5 Years of Age Immunized

Sector









Number of
Persons








I
Percent Immunized
Polio









Diphtheria









Pertussis









Tetanus









Mumps









Measles









Rubella









                              -105-

-------
          Table 5-4




      Health Index Survey
        (Community)




Occurrence of Chronic Diseases
Sector









Number of
Persons









Percent of Persons With Chronic Disease
Allergy









Asthma









Bronchitis









Emphysema









Any Chronic
Disease









                      -106-

-------
         Table 5-5
    Health Index Survey
       ( Community)




Occurrence of Recent Illness
Sector









Number of
Persons









Percent of Persons 111 Within 2 Previous Weeks
Upper
Respiratory
Infection









Cough









Asthma
or
Allergy









Diarrhea









Eye
Irritation









Any
Illness









                     -107-

-------
                 Table 5-6
             Health Index Survey
               (Community)




Occurrence of Problems Related to Mental Health
Sector










Number
of
Households









Percent of Households Where Problem Was Reported
Problem
Children









Legal
Difficulties









Alcohol









Drugs









Emotional
Difficulties









Financial
Difficulties









Unem-
ployment









Any
Stressful
Situation









                            -108

-------
6. RESOURCES FOR HEALTH SERVICES (INVENTORY OF PERSONNEL AND FACIL-
   ITIES)

     This section describes procedures for preparing a community

inventory of personnel and facilities available to provide various

types of health services.  Such information is necessary to deter-

mine the adequacy of existing resources to meet the needs for health

services defined by the procedures outlined in this manual and to

assist in planning for additional resources where necessary.  Tables

6-1 through 6-6 illustrate the forms recommended for summarizing

essential data.

     Before undertaking collection of these data you should dis-

cuss your needs with the Health Systems Agency for your area (see

Appendix) .   Some of the data you need may be readily available and

the Health Systems Agency can assist you with the inventory.


Conducting the Inventory

     The first step in developing the inventory of resources for

health services is to determine where health services are avail-

able for residents of the community.  The location of sources of

health services, other than those in the community being evaluated,

should be listed on the form shown in Table 6-1 together with the

information concerning population,  distance, and accessibility.

All communities where health services are available within an aver-

age driving time of 20 minutes should be listed first.  Other com-

munities where health services are secured by a majority of resi-

dents in the community being evaluated should then be listed in

order of increasing driving time.  These communities will generally

be within 90 minutes average driving time of the community being


                              -109-

-------
evaluated.  If, however, the only services available are at a
greater distance, their location should be listed,  Sources of high-
ly specialized and seldom used services should not be listed if they
are at distances that require more than 90 minutes average driv-
ing time.
     Resources for health services available in the community being
evaluated and those available in the communities listed in Table
6-1 should be summarized in Tables 6-2 through 6-6.  Data for the
community being evaluated should be entered in the first column,
Data for the remaining communities should then be provided in the
following columns in order of increasing driving time,

Arrangement of Forms
     The form for recording the number of and location of person-
nel is shown in Table 6-2.  Provision is made for identifying the
possible sources of health services for residents of the community,
indicating the accessibility in terms of average driving time, and
tabulating the number of the health service providers according to
their profession.  The specialization of physicians should be de-
termined when more than five are located in a community.  The form
shown in Table 6-3 should be used for this purpose.
     Similar form should be used for summarizing information con-
cerning facilities where health services are provided.  The form
illustrated in Table 6-4 should be used to indicate the number of
facilities,  by type, in the community being evaluated, and also
the communities listed in Table 6-1.  The form illustrated in Table
6-5 should be used to provide detailed information concerning capa-
                              -110-

-------
 city,  types  of  services, and extent of use of available  hospitals.



 Table  6-6  should be used for similar  data relating  to nursing homes.








 Sources  of Information



     Essentially all of the data needed for the health resources



 inventory  are readily available.  Information should first  be sought



 from your  Health Systems Agency and the State Health Planning and



 Development  Agency  (see Appendix).  Most states, and many local



 agencies,  have  conducted health manpower surveys that provide data



 concerning personnel.  State plans for health facilities usually



 are  prepared annually to determine adequacy and projected needs



 for  health facilities in designated service areas.  These reports



 provide  information relating to estimated population projections,



 current  capacity and extent of use of various types of health facil-



 ities, and other factors that can be  extracted directly  for the in-



 ventory.



     State and  local professional societies and state licensing



 boards can provide data concerning the number and location  of prac-



 titioners  for which licenses are required.  The stati and county



 departments  can provide information relating to public health per-



 sonnel and probably other health personnel.



     Information relating to hospitals can be obtained directly



 from "Guides to the Health Care Field" published annually by the



 American Hospital Association.  Most hospitals have a copy,  referred



'to as the  "Guide Issue," which should be available for use.   The



 data concerning hospitals in Table 6-4 and all of the data  in



 Table 6-5  can be obtained from the "Guide Issue."
                              -Ill-

-------
     After data are obtained from the sources indicated, rough



drafts of Tables 6-1 through 6-6 should be prepared,  The appropri-



ate professional associations and institutions should be requested



to check them for accuracy and incorporate any changes since the



source data were collected.
                              -112-

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                                         Table 6-1
                          Inventory of Resources for Health Services
                                        (community)




Name, Population, Distance, and Accessibility of Communities Where Health Seivices Are Available
Community (Name)













Population
1970













1975













Distance
(miles)













Driving Time (minutes)
Minimum






.






Maximum













                                                  -113-

-------
                       Table 6-2




        Inventory of Resources for Health Services
                      (community)




Number and Types of Personnel Available for Health Services

Name of Community
Average Driving
Time (minutes)
1

^XC
2


3


4


5


6


7


8


Profession Number
M.D.
D.O.
Dentist
Nurse Practitioner
Physician's Assistant
Registered Nurse
Licensed Practical Nurse
Nurse's Aid
Public Health Nurse
Emergency Medical Technician
Pharmacist
Optometrist
Podiatrist
Physical Therapist
Other (specify)
Other (specify)
































































































































                            -114-

-------
                                                                      Table 6-3

                                                       Inventory of Resources for Health Services
                                                                    (Community)

                           Number and Type of Medical Specialists in Accessible Communities with More Than Five Practitioners
Name of Community








Average Driving
Time








General
Practice
MD








DO








Family
Practice
MD








DO








Internal
Medicine
MD








DO








Obstetrics and
Gynecology
MD








DO








Pediatrics
MD








DO








Surg(
Gene
MD








-ry.
ral
DO








Other (Code)

MD








DO









MD








DO









MD








DC








 1.  Administrative Medicine
 2.  Aerospace Medicine
 3.  Allergy
 4.  Anesthesiology
 5.  Broncho-Esophagology
 6.  Cardiovascular Diseases
 7.  Dermatology
 8.  Diabetes
 9.  Endocrinology
10.  Gas troenterology
11.  General Preventive Medicine
12.  Geriatrics
13.  Hematology
14.  Hypnosis
15.  Infectious Diseases
16.  Laryngology
17.  Legal Medicine
18,  Neoplastic Diseases
19.  Nephrology
20.  Neurology
21.  Neurology, Child
22.  Nuclear Medicine
23.  Nutrition
24.  Occupational Medicine
25.  Ophthalmology
26.  Otoloty
27.  Otorhinolaryngology
28.  Pathology
29.  Pathology, Clinical
30.  Pathology, Forensic
Fields of Practice

               31.
               32.
               33.
               34.
               35.
               36.
               37.
               38.
               39.
               40.
               41.
               42.
               43.
               44.
               45.
Pediatrics, Allergy
Pediatrics, Cardiology
Pharmacology, Clinical
Physical Med. & Rehabilitation
Psychiatry
Psychiatry, Child
Psychoanalysis
Psychosomatic Medicine
Public Health
Pulmonary Diseases
Radiology
Radiology, Diagnostic
Radiology, Pediatric
Radiology, Therapeutic
Rheumatology
46. Rhinology
47. Surgery, Abdominal
48. Surgery, Cardiovascular
49. Surgery, Colou and Rectal
50. Surgery, Hand
51. Surgery, Head and Neck
52. Surgery, Neurological
53. Surgery, Orthopedic
54. Surgery, Pediatric
55. Surgery, Plastic
56. Surgery, Thoracic
57. Surgery,  Traumatic
58. Surgery,  Urological
                                                                          -115-

-------
                       Table 6-4




        Inventory of Resources for Health Services
                      (community)




Number of Types of Facilities Available for Health Services

Name of Community
Average Driving
Time (minutes)
Type of Facility
Ho-nital KTumber
r— NQ> of Bedg
Infirmary
Diagnostic and
Treatment Center
Outpatient Survival Facility
Outpatient Medical Facility
First Aid Station
VT. . Ir Number
e No . of Beds
Physician's Office
Dentist's Office
Nurse Practitioner's Office
Physician's Assistant's Office
Health Department
School Health Office
Drug Store
Other (specify)
1

^xd
2


3


4


5


6


7


8


Number






















































»

















































































                                 -116-

-------
                                                   HOSPITAL CODES
                                             (For  Use  With Table  6-5)
            FACILITIES

  1 - Postoperative recovery room
  2 - Intensive cardiac care unit
  3 - Intensive care unit
  4 - Open-heart surgery facilities
  5 - Pharmacy with FT registered pharmacist
  6 - Pharmacy with PT registered pharmacist
  7 - X-ray therapy
  8 - Cobalt therapy
  9 - Radium therapy
 10 - Diagnostic radloisotope facility
 11 - Therapeutic radloisotope facility
 12 - Hlstopathology laboratory
 13 - Organ bank
 14 - Blood bank
 IS - Electroencephalography
 16 - Inhalation therapy department
 17 - Premature nursery
 18 - Self-care unit
 19 - Extended care or long-term nursing
     care unit
 20 - Inpatient renal dialysis
 21 - Outpatient renal dialysis
 22 - Burn care unit
 23 - Physical therapy department
 24 - Occupational therapy department
 25 - Rehabilitation Inpatient unit
 26 - Rehabilitation outpatient unit
 27 - Psychiatric Inpatient unit
 28 - Psychiatric outpatient unit
 29 - Psychiatric partial hospltallzatlon
     program
 30 - Psychiatric emergency services
 31 - Psychiatric foster and/or home care
 32 - Psychiatric consultation and
     education services
 33 - Clinical psychologist services
 34 - Organized outpatient department
 35 - Emergency department
 36 - Social work department
 37 - Family planning service
 38 - Genetic counseling service
 39 - Abortion service (Inpatient)
 40 - Abortion service (outpatient)
41 - Home care department
42 - Dental services
43 - Podiatrist services
44 - Speech therapist services
45 - Hospital auxiliary
46 - Volunteer services department
          CONTROL

 Government, noiiicderal
 12 - State
 13 - Tjunty
 14 - City
 15 - City-county
 16 - Hospital district or authority

 Nongovernment not-for-profit
 21 - Church operated
 23 - Other

 Investor-owned (for profit)
 31 - Individual
 32 - Partnership
 33 - Corporation

 Goverr"-uint, federal
 41 - Air Force
 42 - Army
 43 - Navy
 44 - Public  Health Service
     other than 47
 45 - Veterans Administration
 46 - Federal other than 41-45,
     47-48
 47 - Public  Health Service
     Indian  Service
 48 - Department of Justice

 Osteopathlc
 61 - Church operated
 63 - Other not-for-profit
 64 - Other
 71 - Individual tor-profit
 72 - Partnership for-profit
 73 - Corporation for-profit
      SERVICE

10 - General medical and surgical
11 - Hospital unit of an institution
     (prison hospital, college
     infirmary, etc.)
12 - Hospital unit within a mental
     retardation school
22 - Psychiatric
33 - Tuberculosis and other
     respiratory diseases
42 - Narcotic addiction
44 - Maternity
45 - Eye, ear nose, and
     throat
46 - Rehabilitation
47 - Orthopedic
48 - Chronic disease
49 - Other specialty*
50 - Children's general
51 - Children's hospital
     unit of an Institution
52 - Children's psychiatric
53 - Children's tuberculosis
     and other respiratory
     diseases
55 - Children's eye, ear,
     nose, and throat
56 - Children's rehabilitation
57 - Children's orthopedic
58 - Children's chronic disease
59 - Children's other specialty*
62 - Institution for mental
     retardation
82 - Alcoholism

     'When a hospital restricts its
     service to a specialty not defined
     by a specific code, It is coded
     49 (59 if a children's hospital)
     and the specialty is Indicated In
     parentheses following the name
     of the hospital.
      STAY

S - Short-term -- average length
    of stay for all patienrs In less
    than 30 days or over 50 percent
    of all patients are admitted to
    units where average length of
    stay is less than 30 days.
L - Lonr-term -- average length
    of stay for all patients is 30 days
    or more or over 50 percent of all
    patients are admitted to units
    where average length of stay Is
    30 days or more.
                        Codes from:       American Hospital Association
                                         "Guide to the Health Care Field"
                                          1975 Edition

                                          American Hospital Association
                                          840 North Lake Shore Drive
                                          Chicago,  Illinois   60611
                                                                     -117-

-------
                        Table 6-5




          Inventory of Resources for Health Services






                      (Community)




Number, Types,  Capacity, and Occupancy of Accessible Hospitals
Community










Name of Hospital











Facilities
(Code)










Classification
(Code)
Control










Service










>.
a
C/3










Inpatient Days
(Code)
w
•o
C)
tt,










Admis-
sions










Census










|S5
0 *—
0 ><
O o










Bassinets










OT
J3
1_>
IH
-**t
M










Personnel










                                 -118-

-------
                                      HOSPITAL CONTROL CODES
                             Government, nonfederal
                             12 - State
                             13 - County
                             14 - City
                             15 - City-county
                             16 - Hospital district or authority

                             Nongovernment not-for-profit
                             21 - Church operated
                             23 - Other

                             Investor-owned (for profit)
                             31 - Individual
,1                            32 - Partnership
5                            33 - Corporation

                             Government, Federal
                             41 - Air Force
                             42 - Army
                             43 - Navy
                             44 - Public Health Service other than 47
                             45 - Veterans Administration
                             46 - Federal other than 41-45,  47-48
                             47 - Public Health Service Indian Service
                             48 - Department of Justice

                             Osteopathic
                             61 - Church operated
                             63 - Other not-for-profit
                             64 - Other
                             71 - Individual for-profit
                             72 - Partnership for-profit
                             73 - Corporation for-profit

-------
              Table 6-6
Inventory of Resources for Health Services
(Community)
Number, Capacity, and Occupancy of Accessible Nursing Homes
Community


'

'





Name of Nursing Home










Control
(Code)










Beds










Admissions










Census










Occupancy
(percent)










                         -120-

-------
                   APPLICATIONS OF INFORMATION










     The information obtained by the methods outlined in the pre-



vious .sections will enable you to identify health problems and de-



velop plans to prevent, alleviate, or eliminate them.  Because



needs are obvious, or appear so, in many instances questions may



be raised as to the necessity of more precise quantitation or



identification of underlying problems and remedial measures.  There



are, however,  substantial reasons for making the evaluations by



the procedures outlined.   In addition to providing accurate, up to



date information, this process enables the orderly development of



priorities and also supplies the data required to obtain support



from various granting agencies where such assistance is needed.



Underlying health problems may be apparent -- in addition to other



ways -- because of the overt occurrence of disease, recognized



deficiencies in the scope or adequacy of available health services,



insufficient personnel to provide health services, and the inade-



quacy of health facilities, or by combinations of these.  Data



compliled or collected by the procedures described and consolidated,



analyzed, and interpreted indicate and quantify such problems.  The



brief explanation and examples provided below suggest some appli-



cations of data resulting from the evaluation described.
                              -121-

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OCCURRENCE OF DISEASE
     The health index survey, as well as data from state and local
reports and other sources, will reveal and to some extent quantify
the^ occurrence of clinical illness.  Comparison of the incidence of
specific diseases, or health indicators, in various sectors of the
community will enable you to define specific geopgraphic location
where occurrence is excessive, that is, above average or expected
rates for the community or area.  Similar comparisons among commu-
nities or comparisons with county, state, or regional rates will
indicate the relative severity of diseases or other problems in the
various communities.  The areas where specific disease problems are
identified should then be evaluated to define the associated envi-
ronmental, behavioral, or other factors.  For most of the diseases
considered in this evaluation, the etiology and epidemiology are
well known,  The majority of analyses involve quantitation, defini-
tion, and description of local circumstances and conditions rather
than exploratory research.
     For example, if an excessive rate of acute respiratory infec-
tions reported as common colds was detected in an area, environ-
ment data would be examined to ascertain if poor housing, inade-
quate heating, ambient toxins, or other factors were positively
correlated with the reports of clinical illness.  Such a correla-
tion leads, of course, to definition of possible remedial measures
that may involve physical alternation of dwelling units.
     Another example illustrates the indication for a different type
of remedial effort,  Consider, for instance, the detection of a
high incidence or excessive recent occurrence of measles or other

                             -122-

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infectious disease preventable by immunization.  The obvious in-
dications are a deficiency in public health programs, specifically
immunization and child health programs, or the failure of residents
to use available services.  These possiblities could be easily
evaluated with data from the health index survey.  Depending on
results of this evaluation, the remedial measures considered might
include the organization of immunization clinics, greater publicity
for available programs, making services more convenient, or further
inquiry to determine why services were not used.
     Similar procedures would be followed in analyzing other indi-
cations of adverse health effects associated with disease occurrence
The specific problems to be explored will be evident from the re-
sults of analyses described in Part 5 of Methods and. Procedures.
Local situations, of course, determine the possibilities for devel-
oping remedial programs or measures.

HEALTH SERVICES
     Data derived from evaluation of community environment services
and the environmental survey (Parts 3 and 4 in Methods and Proce-
dures) together with those from the community profile, and other
sources,  will indicate the adequacy and needs for services relating
to water supplies, sewage disposal, solid waste disposal, and gen-
eral sanitation.  Procedures for consolidation and analyses to
characterize the entire community and various sectors of the commu-
nity with respect to these services are included in Methods and
Procedures.  The state agencies responsible for community environ-
mental services (see Appendix) should be consulted in the develop-
                              -123-

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merit of information from these data to assure conformance with
pertinent regulation and procedure for developing applications for
assistance should this be necessary.
     Needs, demands, or expectations of availability of public
health services will be derived from the health index survey.  Some
information will result from analysis of disease problems, as out-
lined above, and other will be obtained from direct responses of
persons interviewed.  This will indicate the extent of use and
adequacy of the scope of existing services as well as the respon-
dents' impressions of what additional services are desirable.  As-
sistance should be sought from the state and local health depart-
ments and health planning agencies in evaluating these data and in
formulating plans for modifying or adding services,

PERSONNEL TO PROVIDE HEALTH SERVICES
     The inventory of resources for health services (Part 6 in
Methods and Procedures) provides the data for determining the ade-
quacy of numbers and types of existing personnel and for defining
additional needs.  This analysis must take into account the re-
quirement for health services determined in other phases of the
evaluation and, most importantly, constraints to developing logisr,
tics imposed by characteristics of the community.
     It is obvious that every conceivable health service, cannot
be provided to afford maximum convenience and accessibility to
everyone who needs services.   A minimum number of potential users
is necessary to warrant, for example, the development of a hospi-
tal, or to attract a physician or dentist to locate in a specific
                              -124-

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community.  Certain highly specialized services, such as burn and
trauma units, can be supported adequately only in large centers
of population.  However, everyone who needs health services, in-
cluding residents of small conmunities,  should have timely access
to appropriate service in a system that provides for prompt refer-
ral to the proper provider and facility.
     In evaluating the adequacy of health services or in planning
health services for a specific population or a community, both
the needs for service and frequency of use of the services must be
taken into account.  Frequency of use depends on the type of ser-
vice, the number of people to whom the service is accessible, and
the number of persons by whom the service is needed.  The idea that
the national average ratio of providers to population (for example,
one physician to 1,200 persons) can be achieved for every community
regardless of size is untenable.   Ways must be sought, however, to
make adequate health services available to everyone regardless of
the place of residence.
     The first step in this direction is the determination of the
availability of health services to residents of the community be-
ing evaluated.  The data obtained by the inventory of resources
for health services (Part 6 of Methods and Procedures) should be
used for this purpose.  The criteria of availability is that an
appropriate provider,  as well as  other resources, must be accessi-
ble within a reasonable access time.  "Reasonable" relates to both
convenience and the urgency of need for which the service is sought.
Some services must be close by and others can be at locations that
require greater access time.  Thus, an appropriate way to evaluate
                             -125-

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availability of health services is by determining the driving time

required to reach the various types of services.  To accomplish

this, the different types of services must be classified according

to the urgency of access or the requirement of convenience.  For

example, the life-saving emergency medical and surgical services

must be readily accessible in the smaller communities, but immedi-

ate availability of elective surgical procedures is not essential.

Similarly, certain public health services, immunization for exam-

ple, must be convenient or they will not be used.

     For purposes of evaluation and planning the various types of

health services may be considered as follows:



Primary Health Services

     These include the health service first sought when medical

care is needed and the preventive and other types of health ser-

vices that should be easily accessible for frequent use.  Prefera-

bly, they should be within 20 minutes driving time.  Specific

examples of types of primary health services are:

         First-aid and limited emergency service
         Diagnostic and screening services
         Preventive health services
         Limited prescription medication
         Non-prescription medication
         Counseling on health problems and sources of appropriate
         services
         Transportation

District Health Services

     These services are broader in scope and generally are not re-

quired as often, need not be as convenient to assure use, or be

accessible as quickly as primary services.  They can be at some
                             -126-

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greater distance, but preferably should be within 45 to 60 minutes

driving time.  The following types of services are included:

         Consultation and support for providers of primary services
         Ambulatory medical and surgical procedures
         Basic emergency services
         General dental services
         Basic clinical laboratory services
         Basic radiography
         General pharmacy services
         Transportation

Regional Health Services

     Regional services are more specialized than district services

but are required less frequently.  The services generally should be

accessible within 90 minutes driving time.  The following types of

services are included:

         Consultation and support for primary and district services
         Specialized medical and surgical services
         Complete emergency services
         Clinical laboratory services
         Radiological services including isotope diagnosis and
         therapy
         Opthalmic services
         General hospital services
         Complete pharmacy services
         Rehabilitation services
         Chronic care and long-stay institutional services
         Transportation

To complete the description, state health services centers provide

services associated with a regional medical center -« for example,

the state medical center -- administration of public health and

sanitation, and planning.  Organizational arrangements vary from

state to state.

     The data from the inventory should be analyzed to determine

the location and adequacy of personnel to provide the various types

of services in each of these groups -- primary, district, and re-

gional.   This will reveal any deficiencies that may exist for the
                             -127-

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community being evaluated and will suggest approaches to meet them,
This planning should be done in collaboration with state and local
health planning agencies.

FACILITIES FOR HEALTH SERVICES
     The adequacy of facilities for health services is evaluated the
same as personnel.  As indicated above, characteristics of the
community -- including size of population -- determine the kinds
and quantity of services needed.  This, in turn, suggests the types
and numbers of health personnel required.  Knowledge of the ser-
vices to be provided and the types of providers determines the types
of facilities that are appropriate.  The evaluation for a community
should be made in the following sequence:  first, the services needed
should be defined; next, the type of personnel required to perform
the services should be identified; and finally, the facilities
appropriate for housing the services should be determined.  The
methods for evaluating the adequacy and needs for services and
personnel were outlined in the preceding sections,  The inventory
of resources for health services also provides the Jata for evalua-
ting the adequacy of facilities.
     Consideration of facilities for health services should involve
the state Health Planning and Development Agency and the Health
Systems Agency,
                             -128-

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                  Ilil
                APPENDIX
   SOURCES OF INFORMATION AND ASSISTANCE



                   FOR



COMMUNITIES IMPACTED BY ENERGY DEVELOPMENTS
                  129-

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                          FEDERAL, REGIONAL, AND MULTISTATE AGENCIES
FEDERAL

  U.S.  Environmental Protection Agency Region VIII
  Office of Energy Activities
  1860 Lincoln Street
  Denver, Colorado  80203
  Telephone:  303/837-3691

       N.L. Hammer

  U.S.  Department of Health, Education, and Welfare Region VIII
  Federal Office Building
  1961. Stout Street
  Denver, Colorado  80202
  Telephone:  303/837-4461

       Hilary H. Conner, M.D.
       Regional Health Administrator

       Dr. Gunner Sydow, Director
       Division of Health Resources Development

       Michael Liebman, Liaison Officer
       National Center for Health Statistics

       James E. Ver Duft, Chief
       Health Planning Branch

       Ralph C. Barnes, Director
       Division of Prevention

       Dean Hungerford, Director
       Division of Health Service

       George Rold
       Office of Intergovernmental Affairs

  Federal Regional Council
  1961 Stout Street
  Denver, Colorado  80202
  Telephone:  303/837-2751

       Russell W. Fitch, Representative
       Federal Energy Administration

  U.S.  Department of Health, Education, and Welfare
  Indian Health Service Area Offices

  Montana and Wyoming:
       2727 Central Avenue
       Post Office Box 2143
       Billings, Montana  59103
       Telphone:  406/585-6452

         Richard J. Anderson, Assistant Area Director
         Environmental Health and Engineering Programs

  North Dakota and South Dakota:
       Aberdeen Area, IHS
       115 - 4th Street, S.E.
       Aberdeen, South Dakota  57401
       Telephone:  605/782-7553
         Bill F. Pearson, Chief
         Office of Environmental Health
  Utah:
       Navajo Area, IHS
       Post Office Box G
       Window Rock, Arizona  86515
       Telephone:  602/871-5851

         Donald G. Myer, Assistant Area Director
         Enviormental Health and Engineering Programs

  Colorado:
       Federal Building and U.S. Courthouse
       500 Gold Avenue, S.W.
       Albuquerque, New Mexico  87101
       Telephone:  505/474-2155

         Perry C. Brackett, Chief
         Office of Environmental Health
    U.S.  Department  of  tiie  Interior
    Oil  Shale  Environmental Advisory Panel
    Room 690,  Building  67
    Denver  Federal Center
    Denver,  Colorado 80225

         Henry 0. Ash
         Executive Director
 REGIONAL  COMMISSIONS

   Old West Regional Commission          Montana
   Room 306-A                            Nebraska
   Fratt  Building                        North Dakota
   Billings, Montana  59102              South Dakota
   Telephone:  406/245-6711

        Beth Givens
        Information Specialist

   Four Corners Regional Commission
   3535 East 30th Street
   Suite  238
   Farmington, New Mexico  87401

   Telephone-   505/327-9626

        Carl A. Larson
        Executive Director

MULTI-STATE OFFICES

   Fort Union Regional Task Forces       Montana
   State Capitol                         North Dakota
   Bismarck,  North Dakota  58505         South Dakota
   Telephone:   701/224-2916              Wyoming

        Sheila Miedema
        Project Coordinator

   PACT Health Planning  Center
   90 Madison  Street
   Suite. 604
   Denver, Colorado  80206
   Telephone:   303/320-0917

        H. Sterling Drumwright
        Associate Director for  Consultation
Arizona
Colorado
New Mexico
Utah
                                                           130-

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                                                       COLORADO
STATE DEPARTMENT OF HEALTH

  Colorado Department of Health
  4210 East llth Avenue
  Denver, Colorado  80220
  Telephone:   303/388-6111
       Anthony Robbing, M.D., M.P.H.
       Executive Director
       Extension 315
       Thomas M. Vernon, M.D.,
       Epidemiology Section
       Extension 252
                               Chief
       Robert E. Fontaine, M.D.
       Epidemic Intelligence Service  (EIS) Officer
       Extension 252

       Orlen J. Wiemsnn, Chief
       Milk, Food, and Drug Section
       Consumer Protection
       Extension 252

       Donald J. Davids, Chief
       Records and Statistical Section
       Extension 237
       (Health Information)

       Frank Rozich, Director
       Water Quality Control and'Public Health
           Engineering
       Extension 325

STATE PLANNING AGENCY

  Division of Planning
  Department of Local Affairs
  1313 Sherman Street, Room 520
  Denver, Colorado  80203
  Telephone:  303/839-2351

       Philip H. Schmuck
       Planning Director

REGIONAL PLANNING COMMISSIONS
Region 1
Sedgwick,  Phillips,  Yuma,  Logan,  Washington
and Morgan Counties
  Northeastern Colorado Council of Governments
  Post Office Box 1782
  Sterling, Colorado  80751
  Telephone:  303/522-0040

       John Harrington, Executive Director

Region 2   Larimer and Weld Counties

  Larimer-Weld Regional Council of Governments
  201 East Fourth Street,  Room 201
  Loveland, Colorado  80537
  Telephone:  303/667-3288

       Ronald Thompson, Director

Region 3   Denver,  Adams,  Arapahoe,  Boulder, Jefferson,
           Douglas,  Clear  Creek,  and Gilpin Counties

  Denver Regional Council  of Governments
  1776 South Jack&on Street, Suite 200
  Denver,  Colorado  80210
  Telephone:   303/758-5166

       Robert D.  Farley, Executive Director

Region 4   El Paso,  Park,  and Teller Counties

  Pikes  Peak Area Council  of Governments
  27 East  Vermijo Avenue
  Colorado Springs,  Colorado  80903
  Telephone:   303/471-7080

       Roland Gaw, Executive Director
Region 5   Lincoln, Elbert, Kit  Carson,  and Cheyemx
           Counties

  East Central Council of Governments
  Box 28
  Stratton, Colorado  80836
  Telephone:  303/348-5562

        Maryjo M. Downey, Director

Region 6 - Crowley, Kiowa, Otero, Bent,  Prowers, am
           Baca Counties

  Lower Arkanasas Valley Council of  Governments
  Bent County Courthouse
  Las Animas, Colorado  81054
  Telephone:  303/456-0692

        James N. Miles, Executive Director

Region 7a - Pueblo County and City of  Pueblo

  Pueblo Area Council of Governments
  One City Hall Place
  Pueblo, Colorado  81003
  Telephone:  303/545-0562

Region 7b   Huerfana and Las Animas  Counties

  Huerfano-Las Animas Area Council of  Governments
  Room 100   County Court House
  Trinidad, Colorado  81082
  Telephone:  303/846-4478

        Fred E.  Weisbrod,  Executive Director

Region 8   Sauache,  Mineral,  Rio Grande, Alamosa,
           Conejos,  and Costilla Counties

  San Luis Valley Council of Governments
  Adams State College, Box 28
  Alamosa,  Colorado  81101
  Telephone:  303/589-7925

        Rondall Phillips,  Director

Region 9   Dolores,  Montezuma, La Plata, San Juan,
           and Archuleta Counties

  San Juan Regional Commission
  1911 North Main
  Durango,  Colorado  81301
  Telephone:  303/259-1691

Region 10   Gunnison,  Delta,  Montrose, Ouray, San
            Miguel,  and Hindsdale Counties

  District 10 Regional Planning  Commission
  107 S.  Cascade
  Post Office Box 341
  Montrose, Colorado  81401
  Telephone:  303/249-9638

        John J.  Collier,  Director

Region 11   Garfield,  Moffat,  Mesa,  and Rio Blanco
            Counties

  Colorado West Area Council of  Governments
  1400 Access Road
  Post Office Box 351
  Rifle,  Colorado  81650
  Telephone:  303/625-1723

        Steve Schmitz, Director

Region 12   Routt,  Jackson,  Grand,  Summit, Eagle, a
            Pitkin Counties

  Northwest Colorado Council of Governments
  Holiday Center Building
  Post Office Box 739
  Frisco,  Colorado  80443
  Telephone:  303/468-5445
                                                       -131-

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                                                   (COLORADO CONT'D)
       Lee Woolsey, Director

Region 13 - Lake, Chaffee, Fremont, and Custer Counties

  Upper Arkansas Area Council of Governments
  6th and Mason, Box 510
  Canon City, Colorado  81212
  Telephone:  303/275-8350

       Frank Cervi, Director

HEALTH PLANNING AND DEVELOPMENT AGENCY

  Colorado Department of Health
  4210 East Eleventh Street
  Denver, Colorado  80220
  Telephone:  303/388-6111

       Anthony Robbins, M.D., Director

  Michael K. Schonbrun, Assistant Director
  Office of Medical Care Regulation and Development
  Extension 356

HEALTH SYSTEMS AGENCIES

Area I
  Central-Northeast Colorado Health Systems Agency, Inc
  7290 Samuel Drive, Suite 316
  Denver, Colorado  80222
  Telephone:  303/427-8460

       June H. Twinam, Executive Director

Area II
  Southeastern Colorado Health Systems Agency, Inc.
  Pikes Peak Center
  1715 Monterey Road
  Colorado Springs, Corlorado  81501
  Telephone:  303/475-9395

       Frank Armstrong, Executive Director

Area III

  Western Colorado Health Systems Agency, Inc.
  2525 NorthSeventh Street
  Grand Junction, Colorado  81501
  Telephone:  303/245-3590

       David Meyer, Executive Director

OFFICE OF ENERGY CONSERVATION

  Office of Energy Conservation
  1313 Sherman, Room 718
  Denver, Colorado  80203
  Telephone:  303/839-2507

  Buie Seawell

SOURCE OF DEMOGRAPHIC DATA

  Colorado Department of Local Affairs
  Division of Planning
  1313 Sherman, Room 520
  Denver, Colorado  80203
  Telephone:  303/829-2351

       Kenneth D. Prince

STATE CARTOGRAPHER

  Louis F. Campbell
  Division of Planning
  Department of Local Affairs
  1313 Sherman Street, Room 520
  Denver, Colorado  80203
  Telephone:  303/839-2351
INDUSTRIAL ECONOMICS DIVISION

  Denver Research Institute
  University of Denver
  Denver,  Colorado  80210
  Telephone.  303/753-3376

       Dr. Alma Lantz,  Research Psychologist

COOPERATIVE EXTENSION SERVICE

  Colorado Extension Service
  Ft. Collins,  Colorado 80523
                                                       -132-

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                                                        MONTANA
STATE DEPARTMENT OF HEALTH

  State Department of Health and Environmental Sciences
  Cogswell Building
  Helena, Montana  59601

       Arthur C. Knight, M.D.,  Director
       Telephone:  406/449-2544

       Martin D. Skinner, M.D., Chief
       Preventive Health Services Bureau
       Telephone:  406/449-2645

       Harry F. Hull, M.D.
       Epidemic Intelligence Service (EIS)  Officer
       Telephone:  406/449-2645

       Vernon E. Sloulin, Chief
       Food and Consumer Safety Bureau
       Telephone:  406/449-2408

       John C.  Wilcon. Chief
       Records  and Statistics Bureau
       Telephone:  406/449-2614
       (Health Information)

       Benjamin F. Wake, Administrator
       Environmental Sciences Division
       Telephone:  406/449-3454

DEPARTMENT OF COMMUNITY AFFAIRS

  Capitol Station
  Helena, Montana  59601
  Telephone:  406/449-3757

       Harold A. Fryslie, Director

       C.R. Draper, Administrator
       Research and Information Systems Division

       Harold M. Price, Administrator
       Planning Division

       Barbara  Garrett, Administrative Officer
       Coal Board

  Department of Natural Resources and Conservation
  37 South Ewing
  Natural Resources Building
  Helena, Montana  59601
  Telephone:  406/449-3780

       John Orth, Director

       Robert Anderson, Administrator
       Energy Planning Division

DISTRICT PLANNING COUNCILS

  District 1   Daniels, Phillips,  Roosevelt,  Sheridan,  and
    and Valley  Counties

       High Plains Provisional  Council for  District  One
       Post Office Box 836
       Scobey,  Montana  592C3
       Telephone:  406/487-5026

         V.C. Tousley, Administrator

  District 4   Blaine, Hill,  and Liberty  Counties

       Bear Paw Development  Corporation of  Northern  Montana
       Post Office Box 1549
       Hill County Courthouse
       Havre, Montana  59501

         Tony Preite,  Executive Director

  District 6   Fergus, Golden Valley,  Judith  Basin,  Musselshell.
    Petroleum,  and Wheatland  Counties

       Central  Montana District Six  Council
       Post Office Box 302
       Roundup,  Montana  59072
     Telephone:   406/323-2547

       Ralph Gildroy,  Director

   District  11    Mineral,  Missoula, and  RavaUi
     Counties

       District  Eleven Council of Governments
       c/o  Board of  County Commissioners
       Missoula  County Courthouse
       Missoula,  Montana   59801

         Gladys  Elison, Director

PLANNING DIRECTORS

   Barbara Keneedy
   Miles City
   City-County Planning Board
   Powder River County  Planning Board
   9  South 6th, #301
   Miles City, Montana   59301
   Telephone:  406/232-6339

   Douglas C. Dean
   Richland  County Planning Board
   Post Office Box 1011
   Sidney, Montana 59720
   Telephone: 406/482-4340

   Eldon Rice
   Rosebud County  Planning  Board
   Route 2
   Forsyth,  Montana   59237
   Telephone:  406/356-7551

   Albion M. Hettich  (Bud)
   Tri-County Planning  Board
   Box 199
   Circle, Montana  59215
   Telephone:  406/485-2622

   Jim Ashbury
   Dawson City-County Planning  Board
   City Hall
   Glendive, Montana  59930
   Telephone:  406/365-5029

   Tom Eggensperger
   Fallon County Planning Board
   County Courthouse
   Baker,  Montana  59313
   Telephone:  406/778-3603

HEALTH PLANNING AND DEVELOPMENT  AGENCY

   State Health Planning and  Resource Development
   Bureau
   836 Front Street
  Helena, Montana
  Telephone:  406/449-3121

       Wallace King,  Chief

HEALTH SYSTEMS AGENCY

  Montana Health Systems Agency
   324 Fuller Avenue
  Helena, Montana  59601
  Telephone:  406/443-5965

       Ralph Gildroy,  Executive  Director

STATE ENERGY OFFICE

  Energy  Research and  Conservation Office
  State Capitol
  Helena,  Montana  59601
  Telephone:  406/449-3940

       Bill Christiansen,  Staff Coordinator
                                                         -133-

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                                                   (MONTANA COHT'D)
BUREAU OF BUSINESS AND ECONOMIC RESEARCH

  School of Business Administration
  University of Montana
  Missoula, Montana  59801
  Telephone:  406/243-0211

       Dr. Maxine C. Johnson, Director

COOPERATIVE EXTENSION SERVICE

  Montana State University
  Bozeman, Montana  59715
  Telephone:  406/994-0211

SOURCES OF DEMOGRAPHIC INFORMATION

  Department of Community Affairs
  Capitol Station
  Helena, Montana  59601
  Telephone:  406/449-2896

       C.R. Draper, Administrator
       Research and Information Systems Division
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                                                     NORTH DAKOTA
STATE DEPARTMENT OF HEALTH

  North Dakota Department of Health
  State Capitol
  Bismarck, North Dakota  58505

       Jonathan B. Weisbuch, M.D.
       State Health Officer
       Telephone:  701/224-2372

       Willis H. Van Heuvelen, Chief
       Environmental Health and Engineering
       Telephone:  701/224-2371


       Kenneth Mosser,  Director
       Communicable Disease Control
       Telephone:  701/224-2376

       Kenneth W. Tardif,  Director
       Environmental Sanitation and Food Protection
       Telephone:  701/224-2360

STATE PLANNING AND RESOURCE AGENCIES

  State Planning Division
  State Capitol, Fourth Floor
  Bismarck, North Dakota  58505
  Telephone:  701/224-2818

       Austin Engle, Director
       Bonnie Austin Banks,  Associate Planner

  State Board for Vocational Education
  State Office Building
  900 East Boulevard
  Bismarck, North Dakota  58505
  Telephone:  701/224-3187

  Coal Impact Information Project
  Cooperative Extension Service
  North Dakota State University
  Fargo, North Dakota  58102
  Telephone:  701/237-7392 or 7393

  Regional Environmental Assessment Program (REAP)
  316 North Fifth Street,  Room 521
  Bismarck, North Dakota  58505
  Telephone:  701/224-3700

       Dr. A.  William Johnson,  Director

  Regional Environmental Impact Statement Office
  1200 Missouri Avenue, Room 105
  Bismarck, North Dakota  58501

       Rebecca Lee
       Community Affaris Specialist

REGIONAL PLANNING ORGANIZATIONS

Region I   Divide McKenzie,  and Williams Counties

  WilHston Basin RC & D
  Law Enforcement Center
  512 Fourth Avenue East
  Williston, North Dakota   58801
  Telephone:  701/572-8191

       Ron Kiedrowski,   Executive Director
                                                           North  Central  Planning Council
                                                           Post Office  Box 651
                                                           Devils Lake, North Dakota  58301
                                                           Telephone:   701/662-8131
Region II
Bottineau,  Burke,  McHenry,  Mountrail,  Pierce,
Renville,  and Ward Counties
  Souris Basin Planning Council
  Minot State College
  Dakota Hall, Room 118
  Minot, North Dakota  58701
  Telephone:   701/839-6641

       Mark Hinthorne,  Executive  Director
                                                         Region  IV
             Grand Forks, Nelson, Pembina, and
             Walsh Counties
Region III
 Benson,  Cavalier,  Eddy,  Ramsey,  Rolette,  and
 Towner Counties
   Red River RC & D
   Post Office Box 633
   Grafton,  North Dakota  58237
   Telephone:   701/352-3550

        Julius Wangler,  Executive Director

 Region V -  Cass,  Ranson,  Richland, Sergent, Steeli
            and Traill Counties

   Lake Agassiz Regional Council
   319 1/2 North Fifth Street
   Post Office Box 428
   Fargo,  North Dakota  58102

        Ervin  Rustad,  Executive Director

 Region VI   Barnes,  Dickey,  Foster,  Griggs,
            LaMoure,  Logan,  Mclntosh,  Stutsman,  an
            Wells Counties

   South Central Dakota  Regional Council
   701 Third Avenue,  SE
   Post Office Box 903
   Jamestown,  North Dakota  58401
   Telephone:   701/252-8060

        Larry  Heisner, Executive Director

 Region VTI    Burleigh,  Emmons,  Grant,  Kidder,
              McLean,  Mercer, Morton, Oliver, Sheritl
              and  Sioux  Counties

   Lewis and Clark 1805  RCD
   801  Boundary  Road
   Mandan, North Dakota
   Telephone:   701/663-6587

       John O'Leary,  Project Director

Region VIII   Adams,  Billings,  Bowman,  Dunn,
              Golden  Valley, Hettinger,  Elope,
              and Stark Counties

   Roosevelt-Custer Regional Council
   19 West First Street
   Dickinson,  North Dakota  58601
   Telephone:  701/227-0647

       Marcoe Drem, Project Coordinator

HEALTH PLANNING ANi> DEVELOPMENT AGENCY

   State Department of Health
   Capitol Building
  Bismarck,  North Dakota   58505
  Telephone:  701/224-2894

       Edward L.  Sypnieski, Director and SHPDA
       Coordinator

  Division of Health Facilities
  Missouri Office Building
  1200 Missouri Avenue
  Bismarck,  North Dakota  58505
  Telephone:  701/224-2352

       Joe Pratschner, Director

  Division of  Health  Statistics
  Capitol  Building
  Bismarck,  North  Dakota  58505
  Telephone:   701/224-2360

       Rick  Blari, Director
                                                           -135-

-------
                                                  (NORTH DAKOTA CONT'D)
HEALTH SYSTEMS AGENCIES

  Western North  Dakota Health  Systems  Agency
  209 North Seventh  Street,  Suite  No.  2
  Bismarck, North  Dakota   58501
  Telephone:  701/223-8085

       Barry Halm, Executive Director

  Agassiz Health Systems  Agency
  123 DeMers Avenue
  East Grand Forks,  MM   56721
  Telephone:  218/773-2471

       Don DeMers, Executive Director

  Min-Dak Health Systems  Agency
  811 South 16th
  Post Office Box  915
  Moorhead, MN   56560
  Telephone:  218/236-2746

       Bruce T.  Briggs, Executive  Director

DISTRICT HEALTH  UNITS

  Custer District  Health  Unit
  210 Second Avenue  Northwest
  Post Office Box  185
  Mandan, North  Dakota   58554
  Telephone:  701/663-4243,  Ext. 46

       Frank E.  Gilchrist, Area  Public Health Administrator

  First District Health Unit
  801 llth Avenue  Southwest
  Post Office Box  1268
  Minot, North Dakota  58701
  Telephone:  701/852-1376

       O.S. Uthus, M.D.,  Executive Director

  Southwestern District Health Unit
  Pulver Hall, Dickinson  College
  Post Office Box  1208
  Dickinson, North Dakota 58601
  Telephone:  701/227-0171

       John E. Fields, Area  Public Health Administrator

  Upper Missouri District Health Unit
  210 First Avenue East
  Post Office Box  756
  Williston, North Dakota 58801
  Telephone:  701/572-3763

       Frank L.  Onufray,  Area Public Health Administrator

  Lake Region District Health Unit
  Ramsey County  Court House
  Post Office Box  844
  Devils Lake, North Dakota  58301
  Telephone:  701/662-4931

       Norman Septon, Area Public  Health Administrator

STATE ENERGY OFFICE

  Governor's Office
  Capitol Building
  Bismarck,  North Dakota  58501
  Telephone:  701/224-2200

       Dr.  Charles  Metzger,  Energy Advisor for
       Governor Arthur A. Link

SOURCES OF DEMOGRAPHIC INFORMATION

  State Board for Vocational Education
  State Office Building
  900 East  Boulevard
  Bismarck  North Dakota  58501
  Telephone:   701/224-3187

  Social  Science Research Institute
  University of  North Dakota
  University Station
  Grand Forks,  North Dakota  58201
  Regional Environmental Assessment Prop.r;im (KKAI1)
  316 North FifLh Street,Room 521
  Bismarck, North Dakota  58505
  Telephone:  701/224-3700

       Dr. A. William Johnson,  Director

COOPERATIVE EXTENSION SERVICE

  North Dakota State University
  State University Station
  Fargo, North Dakota  58102

       Dr. Norbert A. Dorow, Economist
       Public Affairs

  North Dakota State University
  Pulber Hall
  Dickinson. North Dakota  58601

       Harry Hecht,  District Director

  County Extension Office
  Weshburn, North Dakota  58577
  Telephone:  701/462-3532

       Don H. Peterson,  Area Resource Development
       Agent

SOCIAL SICENCE RESEARCH  INSTITUTE

  University of North Dakota
  Grand Forks, North Dakota  58201

       Dr. Richard L. Ludtke,  Director

BUREAU OF BUSINESS AND ECONOMIC RESEARCH

  University of North Dakota
  286 Gamble Hall
  Grand Forks, North Dakota  58201

INDUSTRIES

  ANG Coal Gasification  Company
  304 East Rosser
  Bismarck, North Dakota  58501
  Telephone:  701/258-7440

       John Clement

  Basin Electric Power Cooperative
  1717 East Interstate Avenue
  Bismarck, North Dakota 58501
  Telephone:  701/223-0441

       Robert L.  Valeu,  Coordinator
       Impact Planning
                                                        -136-

-------
                                                     SOUTH DAKOTA
STATE DEPARTMENT OF HEALTH

  South Dakota State Department of Health
  State Office Building #2
  Pierre, South Dakota  57501

       Edward DeAntoni, Ph.D., Secretary of Health
       Telephone:  605/224-3361

       James D. Corning, Director
       Communicable Disease Control and Laboratory Services
       Telephone:  605/224-3143

       Howard Hutchings, Chief
       Section of Environmental Sanitation
       Telephone:  605/224-3141

       William Johnson
       Office of Public Health Statistics
       Joe Fosse Office Building
       Pierre, South Dakota  57501
       Telephone:  605/224-3355
       (Health Information)

       Sherman Folland, Ph.D., Health Economist
       Health Manpower and Linkage Project

  STATE PLANNING AND RESOURCES AGENCIES

  State Planning Bureau
  State Capitol Building
  Pierre, South Dakota  57501
  Telephone:  605/224-3661

       Dan Bucks, Conjnissioner

  Department of Environmental Protection
  State Office Building
  Pierre, South Dakota  57501
  Telephone:  605/224-3351

       Dr. Allyn 0. Lockner, Secretary

PLANNING AND DEVELOPMENT DISTRICTS

District I   Brookings, Clark, Codington, Deuel,  Grant,
             Hamlin, Kingsbury, Lake, Miner,  and  Moody Counties

  Planning and Development District I
  401 1st Avenue, Northeast
  Watertown, South Dakota  57201
  Telephone:  605/886-7224
       Lowell D. Richards, Director
District II
Clay,  Lincoln,  HcCook ,
  and Union Counties
                                     Minnehaha ,  Turner,
  Planning and Development District II
  (South Eastern Council of Governments)
  208 East 13th
  Sioux Falls, South Dakota  57102
  Telephone:   605/336-1297

       William R.  Choate,  Director

District III    Aurora,  Bon Homme,  Brule,  Charles Mix,  Davison,
               Douglas,  Gregory,  Hanson,  Hutchinson,  Jerauld,
               Sanborn,  and Yankton Counties

  Planning and Development District III
  Yankton County Courthouse
  Post Office Box  687
  Yankton,  South Dakota   57078
  Telephone:   605/665-4408

       Herman Tushaus,  Director
District IV
              Beadle,  Brown,  Day,  Edmunds,  Faulk,  Hand,
              Marshall,  McPherson,  Spink,  and  Roberts  Counties
  Planning and Development District IV
  310 S. Lincoln
  Aberdeen,  South Dakota  57401
  Telphone.   605/229-4740

       Larry Rehfeld,  Director
                                                      District V - Armstrong,  Buffalo,  Campbell,  Carson
                                                                   Dewey. Haakon,  Hughes,  Hydr,  Jones,
                                                                   Lyman, Mellette,  Perkins,  Potter,  Si,
                                                                   ley, Sully, Todd,  Tripp,  Walworth,
                                                                   and Ziebach Counties

                                                        Planning and Development  District  V
                                                        365 1/2 S. Pierre Street
                                                        Post Office Box 640
                                                        Pierre, South Dakota   57501
                                                        Telephone:  605/224-1623

                                                             Dennis W. Potter, Director

                                                      District VI   Bennett,  Butte,  Custer,  Fall  River,
                                                                    Harding,  Jackson,  Lawrence, Meade,
                                                                    Pennington,  Shannon, Washabaugh,  an
                                                                    Washington Counties

                                                        Sixth District Council of Local  Governments
                                                        306 East Saint Joe
                                                        Post Office Box 1586
                                                        Rapid City, South Dakota   57701
                                                        Telephone:  605/342-8241

                                                             Larry Finnerty,  Director

                                                      HEALTH PLANNING AND DEVELOPMENT AGENCY

                                                        Edward DeAntoni, Ph.D.
                                                        Secretary of Health
                                                        Department of Health
                                                        State Office Building #2
                                                        Pierre, South Dakota   57501
                                                        Telephone:  605/224-3361
  Donald G. Karvink, Director
  Office of State Health Planning  and  Development
  Telephone:  605/224-3693

HEALTH SYSTEMS AGENCY

  South Dakota Health Systems Agency,  Inc.
  216 East Clark Street"
  Vermillion, South Dakota  57069
  Telephone:  605/624-4446

       Donald Brekke, Executive Director

STATE ENERGY OFFICE

  Office of Energy Policy
  State Capitol Building'
  Pierre, South Dakota   75701
  Telephone:  605/224-3603

       James Van Loan, Director
       John Culbertson,  Deputy Director

BUSINESS RESEARCH BUREAU

  School of Business
  University of South Dakota
  Vermillion, South Dakota  57069

COOPERATIVE EXTENSION SERVICE

  South Dakota State University
  Brookings, South Dakota  57006

SOURCE OF DEMOGRAPHIC INFORMATION

  Rural Sociology Department
  Agricultural Experiment- Station
  South. Dakota State University
  Brookings,  South Dakota  57006

  William Bergsn
  University of  South  Dakota
  Vermillion,  South  Dakota   57069
                                                         137-

-------
                                                          UTAH
STATE DEPARTMENT OF SOCIAL SERVICES

  Utah State Division of Health
  150 West North Temple
  Room 474
  Salt Lake City, Utah  84103

       Lyman J. Olsen, M.D., M.P.H.
       Director of Health
       Telephone:  801/533-6111

       Taira Fukushima, K.D., M.P.H.
       Deputy Director of Health
       Room 460
       Telephone:  801/533-6191

       E. Arnold Isaacson, M.D., M.P.H.
       Deputy Director of Health for Community
         Health Services
       Room 440
       Telephone:  801/533-6129

       Alan G. Barbour, M.D., (EIS) Officer
       Epidemic Intelligence Service
       Room 426
       Telephone:  801/533-6163

       Mervin R.  Reid, Director
       Bureau of Sanitation
       Environmental Health Services
       Room 430
       Telephone:  801/533-6163

       Lynn M. Thatcher
       Deputy Director of Health for
         Environmental Health Services
       Room 430
       Telephone:  801/533-6121

       Howard M.  Hurst, Director
       Bureau of Environmental Health
       Room 430
       Telephone:  801/533-6121

       John Brockert,  Director
       Bureau of Statistical Services
       Room 158
       Telephone:  801/533-6186

STATE PLANNING AGENCIES

  Office of State Planning Coordinator
  State Capitol Building
  Room 118
  Salt Lake City.  Utah  84114
  Telephone:   801/533-5356

       James  Edwin Kee
       State  Planning  Coordinator

  Department  of Community Affairs
  State Capitol Building
  Salt Lake City,  Utah  84114
  Telephone:   801/533-5236

       Beth S.  Jarman
       Executive  Director

  Division of Energy Conservation and Development
  455 East 4th South
  Suite 300
  Salt Lake City,  Utah  84111
  Telephone:   533-6491

       Rhead  Searle, Executive Secretary
       Energy  Conservation  and Development  Council
                                                 -138-
MULTI-COUNTY ASSOCIATIONS OF GOVERNMENTS

  Bear River--Box Elder,  Cache,  and Rich Counties

       Bear River Association of Governments
       160 North Main Street
       Room 203
       Cache County Hall  of Justice
       Logan, Utah  84321
       Telephone:  752-7721

         Bruce King
         Executive Director

  Wasatch Front -- Davis, Morgan,  Salt Lake, Tootle.
    and Weber Counties

       Wasatch Front Regional Council
       424 West Center Street
       Bountiful, Utah  84010
       Telephone:  801/292-4469

         Will Jeffries
         Executive Director

  Mountainland -- Summit, Utah,  and Wasatch Counties

       Mountainland Association  of Governments
       160 East Center Street
       Provo. Utah  84601
       Telephone:  801/377-2262

         Homer Chandler
         Executive Director

  Six County -- Juab,  Millard,  Piute, Sanpete,
    Sevier, and Wayne Counties

       Six County Commissioners  Organization
       Post Office Box 191
       Richfield, Utah  84701
       Telephone:  801/896-4676

  Five County -- Beaver,  Garfield,  Iron, Kane, and
    Washington Counties

       Five County Association  of Governments
       Post Office Box 0
       St. George, Utah  84770
       Telephone:  801/673-3548

         Rhead Bowman
         Executive Director

  Unitah Basin -- Daggett, Duchesne,  and Unitah
    Counties

       Unitah Basin Association  of  Governments
       Post Office Box 1449
       Roosevelt, Utah 84066
       Telephone:  801/722-4518

         Clint Harrison
         Executive Director

       Energy Planning Council
       Unitah County Building
       Room 303
       Vernal, Utah  84073
       Telephone:   801/789-2300

         Chuck Henderson
         Director

  Southeastern -- Carbon,  Emery.  Grand,  and San Juan
    Counties

       Southeastern Association  of  Governments
       Post Office Drawer A-l
       Price,  Utah  84501
       Telephone:   801/637-1396

         William K.  Dinehart
         Executive Director

-------
                                                      (UTAH  CONT'D)
HEALTH PLANNING AND DEVELOPMENT  AGENCY

  Department of Social Services
  150 West North Temple
  Room 310
  Salt Lake City, Utah  84103
  Telephone:  801/533-5331

       Anthony W. Mitchell
       Director

  State Health Planning and Development Agency

  Office of Planning and Research
  150 West North Temple
  Room 333
  Salt Lake City, Utah  84103

       Stewart C. Smith
       Assistant Director
University of Utah Medical Center
Department of Family and Community  Medicine
50 North Medical Drive
Salt Lake City, Utah  94132
Telephone:  801/581-5094

     Dr. Richard F.H. Kirk
     Division of Family Practice

Utah Valley Hospital
1034 North Fifth West
Provo, Utah  84601
Telephone:  801/373-7850

     Mark J. Howard
     Director of Rural Health
HEALTH SYSTEMS AGENCY

   Utah Health Systems Agency
   19 West  South Temple
   8ch Floor
   Salt Lake City, Utah  84103
   Telephone:  801/571-3476

       Paul Bomboulian
       Director

STATE ENERGY OFFICE

   Department of Natural Resources
   State of Utah
   State Capital Building
   Room 438
   Salt Lake City, Utah  84114

       Clifford R. Collins
       State Energy Coordinator

SOURCE OF  DEMOGRAPHIC INFORMATION

   Office of State Planning Coordinator
   State Capitol Building
   Room 118
   Salt Lake City, Utah  84114
   Telephone:  801/533-5245

       James Edwin Kee
       State Planning Coordinator

COOPERATIVE EXTENSION SERVICE

   Utah State University
   Logan, Utah  84322
   Telephone:  801/752-0961

       William F. Farnsworth
       Staff Development Leader

INSTITUTE  OF GOVERNMENT SERVICE

   Brigham  Young University
   Provo, Utah  84602
   Telephone:  801/374-1211

       Dr. Doyle W.  Buckwalter
       Associate Director

BUREAU OF  COMMUNITY DEVELOPMENT

   University of Utah
   1141 Annex Building
  Salt Lake City,  Utah   84112
  Telephone:   801/581-6491

       Dr.  Richard P.  Lindsay
       Director

HEALTH SERVICES  ORGANIZATIONS

  Health System Research Institute
  715 East 3900  South
  Suite  205
  Salt Lake City,  Utah  84107
  Telephone:   801/261-1000

       George  F.  Powell, Jr.
                                                           -139-

-------
                                                        WYOMING
STATE DEPARTMENT OF HEALTH

  Wyoming 'Division of Health and Medical Services
  Hachaway Building, Fourth Floor
  Cheyenne, Wyoming  92002

       Lawrence J. Cohen, M.D.
       Administrator
       Telephone:  307/777-7121

       H.S. Parish, M.D., M.P.H.
       Assistant State Administrator for Division
         of Health and Medical Services
       Telephone:  307/777-7513

       Robert L. Coffman, Director
       Food and General Sanitation Division
       Telephone:  307/777-7358

       Jo Ann Amen, Deputy State Registrar
       Vital Records Services
       Division of Health and Medical Services
       Department of Health and Social Services
       Cheyenne, Wyoming  82002
       Telephone:  307/777-7591

STATE PLANNING AND RESOURCES AGENCIES

  Department of Economic Planning and Development
  Barrett Building, Third Floor
  Cheyenne, Wyoming  82002
  Telephone:  307/777-7284

       Sherman Karcher, Director

  Department of Environmental Quality
  Water Quality Division
  Hathaway Building
  Cheyenne, Wyoming  82002
  Telephone:  307/777-7781

       William L. Garland, Administrator

  Wyoming Community Development Authority
  139 West Second
  Casper, Wyoming  82602
  Telephone:  307/265-0603

CITY-COUNTY PLANNING AGENCIES

  Lincoln-Uinta Association of Governments
  Post Office Box 389
  Kemmerer, Wyoming  83101
  Telephone:  307/877-3707

       Richard Jentzsch, Executive Director

  Cheyenne-Laramie County Regional Planning Office
  Post Office Box 3232
  Cheyenne, Wyoming  82001
  Telephone:  307/635-0186

       Peter L. Innis,  Director of Planning

  Rawlins-Carbon County Regional Planning Office
  Box 953
  Rawlins, Wyoming  92301
  Telephone:  307/324-5613

       Herb Hogue, Director of Planning

  Casper-Natrona County Planning Office
  Intermountain Building
  Casper, Wyoming  83601
  Telephone:  307/235-6503

       Charles L. "ChucV" Davis,  City-County Planner

  Sweetwater County Planning and Zoning Commission
  Post Office Box 791
  Green River, Wyoming  82935
  Telephone:  307/875-2611,  Extension 270

       Dennis Watt, Planning Director
  Regional Planning Office
  Box 228
  Basin,  Wyoming  82410
  Telephone:   307/568-2566
       Newell Sorensen,  Director of Planning

  Laramie-Albany County  Regional Planning Office
  Albany County Courthouse
  Room 402
  Laramie, Wyoming  82070
  Telephone:   307/742-3166

       Nakul  "Nick" Vertna, City-County Planning
         Director

  Converse Area Planning Office
  Post Office Box 1303
  Douglas, Wyoming  82633
  Telephone:   307/358-4066

       Al Straessle,  City-County Planner

  Department  of Planning and Development
  City of Gillette-Campbell County
  Post Office Box 540
  Gillette, Wyoming  82716

       Joe Racine, Director

  Rock Springs Planning  Office
  Rock Springs, Wyoming   82901
  Telephone:   307/362-6892

  Platte County Joint Planning Office
  Post Office Box 718
  Wheatland,  Wyoming  82201
  Telephone:   307/322-9128

       David  Sneesby, Planning Director

  Sheridan Area Planning Agency
  Post Office Box 652
  Sheridan, Wyoming  82801
  Telephone:   307/672-3426

       Les Jayne,  Planning Director

  Fremont Association of Governments
  191 South Fourth
  Lander, Wyoming  82520
  Telephone:   307/332-9208

       Tom Curren, Executive Director

  Northeast Wyoming Three County Joint Powers  Board
  Post Office Box 743
  Newcastle,  Wyoming  82701
  Telephone:   307/746-2433

       Abbie  Birmingham, Director

  Fremont County
  County Courthouse
  Lander, Wyoming  82520
  Telephone:   307/332-5371

       Ron Martin, Planning Director

INDUSTRIAL ORGANIZATIONS

  Missouri Basin Power Project
  Post Office Box 518
  Wheatland,  Wyoming   82201
  Telephone:   307/322-9121

       Tim Rafferty,  Impact Coordinator

  Southwest Wyoming Industrial Association
  638 Elias
  Rock Springs , Wyoming   82901
  Telephone:   307/382-4190

       Kim Brlggs, Executive Director
                                                      -140-

-------
                                                   (WYOMING CONT'D)
HEALTH PLANNING AND DEVELOPMENT AGENCY

  Lawrence Cohen, M.D., Director
  Department of Health and Medical Services
  Hathaway Building, Fourth Floor
  Cheyenne, Wyoming  92002
  Telephone-  307/777-7121

  Lawrence Bertilson, Director
  Comprehensive Health Planning
  Hathaway Building, Fourth Floor
  Cheyenne, Wyoming  82002
  Telephone:  307/777-7121

HEALTH SYSTEMS AGENCY

  Wyoming Health Systems Agency
  Post Office Box 106
  Cheyenne, Wyoming  82001
  Telephone:  307/634-2726

       Richard M. Neibaur, Executive Director

STATE ENERGY OFFICE

  Department of Economic Planning and Development
  Barrett Building,  Third Floor
  Cheyenne, Wyoming  82002
  Telephone:  307/777-7284

       John Niland,  Executive Director
       John Goodier, Chief of Mineral Division

SOURCE OF DEMOGRAPHIC INFORMATION

  Economic Research Unit
  State Planning Coordinator's Office
  24th and Capitol Avenue
  Cheyenne, Wyoming  82002
  Telephone:  307/777-7504

  Division of Business and Economic Research
  University of Wyoming
  Post Office Box 3295
  Laramie, Wyoming  82071
  Telephone:  307/766-5141

       Dr. Mike Joehnk, Director

WYOMING HUMAN SERVICES PROJECT

  University of Wyoming
  Merica Hall 207
  Laramie, Wyoming  82071
  Telephone:  307/766-6318

       Dr. Keith A.  Miller,  Project Director

  Gillette Human Services Project
  202 Warren Ave.
  Post Office Box 1104
  Gillette, Wyoming   82716
  Telephone:  307/682-4219

       JoAnn Shurigar-Wzorek
       Community Coordinator

  Platte County Human Services Project
  962 Gilchrist Ave.
  Wheatland,  Wyoming  82201
  Telephone:   307/322-4480

       Sharron Kelsey,  Field Director
HEALTH PLANNING RESOURCE CENTER

  Institute for Policy Research
  Post Office Box 3925
  University of Wyoming
  Laramie, WY  82071
  Telephone:  307/766-5141

       Dr. George Piccagli, Director

COOPERATIVE EXTENSION SERVICE

  College of Agriculture
  Post Office Box 3354
  University of Wyoming
  Laramie, Wyoming  82071
  Telephone:  307/766-3253

       Josephine B.  Rund, State Extension Leader
       Home Econonomics
                                                           -141-

-------
                                   TECHNICAL REPORT DATA
                            (Please read Instructions on the reverse before completing)
 .REPORT NO.
    EPA-908/4-77-012
2.
                              3. RECIPIENT'S ACCESSION NO.
4. TITLE AND SUBTITLE
 PROCEDURES FOR EVALUATING HEALTH IMPACTS RESULTING
 FROM DEVELOPMENT OF ENERGY RESOURCES
                                                           5.. REPORT DATE
                                                             November 1977
                              6. PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
                                                           8. PERFORMING ORGANIZATION REPORT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS

  Copley  International Corporation
  7817 Herschel Avenue
  La Jolla,  California  92037
                                                            10. PROGRAM ELEMENT NO.
                              11. CONTRACT/GRANT NO.

                                68-01-1949
 12. SPONSORING AGENCY NAME AND ADDRESS
 Environmental Protection Agency,  Region VIII
 Office  of Energy Activities
 1860 Lincoln Street
 Denver,  Colorado  80295
                              13. TYPE OF REPORT AND PERIOD COVERED
                                Final
                              14. SPONSORING AGENCY CODE
 15. SUPPLEMENTARY NOTES
  In addition to this manual,  a  document entitled "Suggestions  for Communities Impacted
  by Energy Developments" and  a  20  minute slide presentation were  prepared.
 16. ABSTRACT
 This manual is a compilation  of formats,  protocols, and procedures  that may be used by
 communities and state agencies  to evaluate health impacts resulting from the develop-
 ment of energy resources.  The  manual also considers ways of using  these evaluations
 to develop plans for coping with health impacts.  It is an outgrowth of a study of
 health  problems experienced by  impacted communities in Colorado, Montana, North Dakota,
 South Dakota,  Utah and Wyoming.   Many communities, especially  small ones, found that
 such problems  required actions  by both elected officials and the general public that
 were new to the community.  This manual was developed to relate what some communities
 have experienced and to suggest ways that a community may assemble  information and
 organize to avoid or overcome undesirable health impacts from  rapid growth.
17.
                                KEY WORDS AND DOCUMENT ANALYSIS
                  DESCRIPTORS
                                              b.IDENTIFIERS/OPEN ENDED TERMS
                                            c.  COS AT I Field/Group
 Energy Development
 Physical  §  Demographic Profile
 Community Environmental Service
 Current Environmental Conditions
 Current Status  of Health
 Resources for Health Services
                 Environmental Survey;
                 Health  Index Survey;
                 Inventory of Health
                 Personal  and Services,
 8. DISTRIBUTION STATEMENT

 DISTRIBUTION UNLIMITED
                                                           SS (This Report)
                                            21. NO. OF PAGES
                                              20. SECURITY CLASS {This page)
                                            22. PRICE
EPA Form 2220-1 (Rev. 4-77)   PREVIOUS EDITION is OBSOLETE

-------
                                                         INSTRUCTIONS

    i.   REPORT NUMBER                                             .
        Insert the EPA report number as it appears on the cover of the publication.

    2.   LEAVE BLANK

    3.   RECIPIENTS ACCESSION NUMBER
        Reserved for use by each report recipient.

    4.   TITLE  AND SUBTITLE                                                                .
        Title should indicate clearly and briefly the subject coverage of the report, and be displayed prominently.  Set subtitle, it used, in smaller
        type or otherwise subordinate it to main  title. When a report is prepared in more than one volume, repeat the primary title, add volume
        number and include subtitle for the specific title.

    5.   REPORT DATE
        Each report shall carry a date indicating at least  month and year.  Indicate the basis on which it was selected (e.g., date of issue, date of
        approval, date of preparation, etc./.

    6.   PERFORMING ORGANIZATION CODE
        Leave blank.

    7.   AUTHOR(S)
        Give name(s) in conventional  order (John R. Doe, J. Robert Doe, etc.).  List author's affiliation if it differs from the performing organi-
        zation.

    8.   PERFORMING ORGANIZATION REPORT NUMBER .
        Insert if performing organization wishes to assign this number.

    9.   PERFORMING ORGANIZATION NAME AND ADDRESS
        Give name, street, city, state,  and ZIP code.  List no more  than two levels of an organizational hirearchy.

    10.  PROGRAM ELEMENT NUMBER
        Use the program element number under which the report was prepared. Subordinate numbers may be included in parentheses.

    11.  CONTRACT/G RANT NUMBE R
        Insert contract or grant number under which report was prepared.

    12.  SPONSORING AGENCY NAME AND ADDRESS
        Include ZIP code.

    13.  TYPE OF REPORT AND PERIOD COVERED
        Indicate interim final, etc., and if applicable, dates covered.

    14.  SPONSORING AGENCY CODE
        Insert appropriate code.

    15.  SUPPLEMENTARY NOTES
        Enter information not included  elsewhere but useful, such  as:  Prepared in cooperation with, Translation of, Presented'at conference of,
        To be published in, Supersedes,  Supplements, etc.

    16.  ABSTRACT
        Include a brief (200 words or less) factual summary of the  most significant information contained in the report. If the report contains a
        significant bibliography or literature survey, mention it here.

    17.  KEY WORDS AND DOCUMENT ANALYSIS
        (a) DESCRIPTORS - Select from the Thesaurus of Engineering and Scientific Terms the proper authorized terms that identify  the major
        concept of the research and are sufficiently specific and precise to be used as index entries for cataloging.

        (b) IDENTIFIERS AND OPEN-ENDED TERMS - Use identifiers for project names, code names, equipment designators, etc. Use open-
        ended terms written in descriptor form for those subjects for which  no descriptor exists.

        (c) COSATI FIELD GROUP - Field and group assignments are to  be taken  from the 1965 COSATI Subject Category List. Since the ma-
        jority of documents are multidisciplinary  in nature, the Primary Field/Group assignment(s) will be specific discipline, area of human
        endeavor, or type of physical object. The application(s) will be cross-referenced with secondary Field/Group assignments that will follow
        the primary posting(s).

    18.  DISTRIBUTION STATEMENT
        Denote  releasability to the public or limitation for reasons  other than security for example "Release Unlimited." Cite any availability to
        the public, with address and price.

    19. &20.  SECURITY CLASSIFICATION
        DO NOT submit classified reports to the National Technical Information service.

    21.  NUMBER OF PAGES
        Insert the total number of pages, including this one and unnumbered pages, but exclude distribution list, if any.

    22.  PRICE
        Insert the price set by the National Technical Information Service or the Government Printing Office, if known.
EPA Form 2220-1  (Rev. 4-77) (Reverse)

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