Pulling Together 4

Getting to Know Your Site, Partners, and Community
WORKSHEET: Key Contacts

This worksheet has been duplicated from Appendix A in Assessment to Action: A Tool for Improving the Health of Communities Affected by Hazardous Waste (pp. 48–52).  It is intended to provide a handy reference sheet of key agencies and individuals related to the site. Contacts include relevant public health and environmental agencies at all levels of government, the range of local agencies representing or servicing a community, community groups, and others associated either with the site or community. This worksheet and the data it reports will need to be updated and maintained throughout the collaborative effort and the duration of site cleanup and health-related activities. It is likely that there will be changes to the lists over time. This worksheet can be completed independently or with the group, but will likely require input from multiple team members. If you choose to complete the worksheet on your own, you will still need to contact the other partners in order to complete the sections pertaining to them. You may choose to complete this before the collaboration begins, or as a first step in the work of the group.

Key Contacts:  Include name, title, organization, address, and telephone number for the contact persons for each category.

Date:          
Completed by:       
Site Name:         

Agency

Local Health Department (LHD) Lead Staff and Public Contacts:

    
State Public Health Agency Contacts:

    
State Environmental Contacts:

   
ATSDR Contacts

Regional Representative:

    
Public Health Assessor:

    
Community Involvement Liaison:

    
Other:

 
    
EPA Contacts

Regional:

    
Community Involvement Coordinator:

    
Remediation Project Manager or On-Scene Coordinator:

    
Brownfields Coordinators:

    
Other:

Local Agency Contacts

Local Information Officer:

    
Local Emergency Planning Committee:

    
Fire Department:

    
Office of Emergency Management:

    
Department of Transportation:

    
Public Works:

    
Assessor's Office:

    
School Board:

    
Planning and Zoning (Land Use):

    
Utilities:

    
Police Department:

    
Department of Housing:

    
Local Healthcare Providers:

Legal Contacts

State Attorney's Office:

    
Judges:

    
Attorneys (include any attorneys representing any party in issues regarding the site):

Community Groups

Key Community Leaders:

    
Cultural/Political Organizations:

    
Civic/Religious Groups:

    
Community Groups Organized Around Site:

    
Technical Assistance Grant (TAG) Recipients:

    
Technical Advisors to TAG Recipients

Other Contacts

Media Contacts:

    
Local Elected Officials:

    
State Elected Officials:

    
Federal Elected Officials:

    
Appointed Officials (City/County Managers, etc.):

    
Current Site Owner:

    
Potentially Responsible Parties (PRPs):

    
Developers:

    
Redevelopment Authority:

    
Department of Natural Resources (state):

Professional and Community Resources

Media Serving the Community:

    
Medical Community:

    
Academia:

    
Local Experts:

    
Technical Experts/Consultants:

 
Community Centers and Social Service Organizations:

    
Information Resources:

Potential Community Liaisons: