MDH Crisis Support Questionnaire (Post–Tai Po Fire) MDH Crisis Support Questionnaire (Post–Tai Po Fire) 1. Full Name 1. Full Name First Name First Name Last Name Last Name 2. Mobile number / WhatsApp number 3. Email address (if any) 4. Nationality 5. Visa status Migrant domestic worker (active contract) Terminated / between jobs Other (specify) 6. Employer’s district before the fire (e.g., Tai Po, Yau Ma Tei) 7. Current location / temporary accommodation With employer With friends In NGO shelter Hotel / temporary housing Not sure / unstable Other (specify) 8. Were you directly affected by the Tai Po fire incident? Yes No (stop form) 9. What did you lose in the crisis? (Select all that apply) Passport HKID Employment contract Clothes Money / personal savings Food supplies Toiletries Phone / device Medication Other (specify) 10. Did you experience any injuries? No Minor injuries Serious injuries (need medical referral) 11. What urgent help do you need right now? (Select all that apply) Food Drinking water Toiletries Clean clothes Temporary accommodation Phone / SIM card Medication Assistance replacing documents (passport, HKID, etc.) Someone to talk to / emotional support Legal support Help contacting employer / agency Financial assistance Transportation support Other (specify) 12. Are you currently safe and have a place to sleep tonight? Yes No Not sure 13. What support do you expect to need in the coming weeks? (Select all that apply) Consistent food support Clothing Toiletries and hygiene supplies Long-term accommodation Emotional / mental health support Group counselling Case managemen Legal advice (employment, rights, etc.) Agency/employer mediation Financial aid Help replacing official documents Re-employment assistance Community support groups Support to send money home Medical check-up Other (specify) 14. Are you currently experiencing stress, fear, trauma, or anxiety because of the incident? Yes Sometimes No Prefer not to say 15. Would you like us to connect you with emotional support professionals? Yes Maybe No 16. Is your employer aware of your situation? Yes No Not sure 17. Do you currently feel secure in your employment after the incident? Yes No Not sure Prefer not to say 18. Do you need assistance communicating with: Employer Employment agency Immigration Department Consulate Police Hospital Authority No assistance needed Other (specify) 19. Do you need help replacing: (Select all that apply) Passport HKID Employment contract Bank card / ATM card Phone / contacts Work uniform None Other (specify) 20. Do you need help dealing with government departments? Immigration Police Labour Department Consulate / Embassy Social Welfare Department No Other (specify) 21. Preferred language of communication: English Tagalog Bahasa Indonesia Other (specify) 22. Best way to contact you: WhatsApp Call SMS Email Contact through another person (provide details) 23. Is there anything else you want us to know about your situation? (Open-ended) 24. Do you give consent for your information to be shared ONLY with trusted NGO partners for the purpose of giving you support? Yes No Submit If you are human, leave this field blank.
