Eco-DRR Assessment Form
Location: 

Date: 

Persons completing the form: 

Types of Hazards Reported: 
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Sources of Information (include contact information if possible): 
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Map
Draw a map of the location noting: 
•	Natural features (rivers, mountains, etc.)
•	Housing and other infrastructure (roads, stores, schools, churches, etc.)
•	Locations of special cultural or environmental significance (e.g., wetland, area of traditional ceremonies, places where special plants grow, etc.)
•	Locations or areas affected by disasters in the past. 
•	Other points of interest. 
(Use the other side of the form or another sheet of paper.)

Hazard/Impact/Environmental Issues/DRR Table
Complete the form during the field work except the column “Eco-system Based Actions”. 
Use as many rows for each hazard as necessary. Add more rows if needed.
Hazard	Impact	Source of Information	Location on Map	Environmental Issues (impacts/causes)	Eco-system Based Actions	Climate Change Issues? 	

							

							

							

							

							

							

							

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