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Thank you for helping the Regional Hoarding Task Force collect data about hoarding situations in the seven – county area listed at the top of this form. Our goal moving forward is to gather evidence to support the need for additional resources in our community. Thank you for your input. If you have further questions, please visit www.palink8.com or contact Melissa Bottorf, PA Link Coordinator at 570-428-3521 or mbottorf2016@gmail.com.
Data Collection Form 
About the Consumer
Are you aware of any code violations related to the hoarding problem?
Is there any structual damage related to the hoarding problem?
If yes, is it:
Are there blocked exits to the home?
Can the consumer vacate the home safely in the event of an emergency?
Are there fire hazards in the home?
Is there moldy or rotten food in the home?
Is there water/heat/electric in the home?
Is there standing water in the home? Sink, tub, basement or other
Is there human or animal waste in the home?
Is there evidence of mold in the home?
Are there piles of dirty or contaiminated objects?
Evidence of bugs, insects, or rodents in the home?
Odor present in the home?
Body odor noted on consumer?
Are bathroom facilieis accessible and functioning?
Is there access to a washer?
Is consumer washing his/her clothes?
Was consumer given the Regional Hoarding Task Force Resource Guide?

Thanks for submitting!

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