Community Capacity Assessment and Reflection on Community Health in [Name of Community] Reflection: In conducting the Community Capacity Assessment, I found that my community has a variety of human and social services and resources available. The closest hospital is [Name of Hospital],

Name/Location of Community
Identify the human and social services or resources in your community, choosing the services located closest to your current address – campus services do not count!
Complete ALL items on the Community Capacity Assessment Form, regardless of location! If the nearest resource is not located within or close to your community, you may address that point in your reflection.
If you are using google searches, BE CAREFUL! The first options you see MAY NOT be correct for the assignment. It is always best to call the agency or view the agency’s website to ensure that they actually provide the resource or service in question.
Community Capacity Assessment
1. Hospital
a. Name of hospital
b. Complete address
c. Phone #
d. Website url
2. Urgent Care Center
a. Name of Urgent Care Center
b. Complete address
c. Phone #
d. Website url
3. Free & income based health care clinic (not a hospital)
a. Name of free & income based health care clinic
b. Complete address
c. Phone #
d. Website url
4. Poison Control Center (there are only 3 in FL!)
a. Name of Poison Control Center
b. Complete address
c. Phone #
d. Website url
5. Blood donation center
a. Name of Blood donation center
b. Complete address
c. Phone #
d. Website url
6. Social Security Office
a. Name of Social Security Office
b. Complete address
c. Phone #
d. Website url
7. Fire/Rescue substation
a. Name of Fire/Rescue substation
b. Complete address
c. Phone #
d. Website url
8. County Sheriff substation
a. Name of County Sheriff Substation
b. Complete address
c. Phone #
d. Website url
9. Community Center
a. Name of Community Center
b. Complete address
c. Phone #
d. Website url
10. Child day care center
a. Name of Child day care center
b. Complete address
c. Phone #
d. Website url
11. Adult/Senior day care center
a. Name of Adult/Senior day care center
b. Complete address
c. Phone #
d. Website url
12. Senior Center
a. Name of Senior Center
b. Complete address
c. Phone #
d. Website url
13. Congregate meal site
a. Name of Congregate meal site
b. Complete address
c. Phone #
d. Website url
14. Domestic violence shelter
a. Name of Domestic violence shelter
b. Complete address
c. Phone #
d. Website url
15. Hazardous waste station
a. Name of Hazardous waste station
b. Complete address
c. Phone #
d. Website url
16. Mental health facility (public, not a private doctor)
a. Name of Mental health facility
b. Complete address
c. Phone #
d. Website url
17. Public Health Department
a. Name of Public Health Department
b. Complete address
c. Phone #
d. Website url
18. Substance abuse treatment facility
a. Name of Substance treatment facility
b. Complete address
c. Phone #
d. Website url
19. Hospice care facility
a. Name of Hospice care facility
b. Complete address
c. Phone #
d. Website url
20. Public library
a. Name of Public library
b. Complete address
c. Phone #
d. Website url
21. City Hall
a. Name of City Hall
b. Complete address
c. Phone #
d. Website url
22. US Congressman from your district
a. Name of US Congressman from your district
b. Complete address
c. Phone #
d. Website url
Reflection Instructions
Write a brief (150 word) paragraph on what you found (or didn’t find) in your community. Discuss what you think this means for community health in your community.
.doc or .docx
double-spaced throughout the document
1-inch margins throughout the document
Times New Roman font, size 12