Emergency Social Services Forms

To order emergency support services (ESS) supplies including promotional items, brochures and training materials, call the Emergency Support Services Program or print the supply order form (PDF) and fax it to (250) 952-4888. 

Use the supply order form to order printed copies of these emergency support service forms. The versions below will open as PDFs and are provided as samples only.




Referral Form

Referrals Unit Workers or Level One ESS responders use this form to refer evacuees to suppliers of food, clothing, lodging etc. The form instructs suppliers to invoice the provincial government.


Referral Form Record

Documentation Unit Workers use this form to record when they issue a Referral Form to a Referrals Unit Worker or a Level One ESS responder.


Emergency Support Services Rates Sheet

ESS volunteers provide this sheet to evacuees along with the Referral Form. It gives the maximum amounts of money evacuees can receive to provide for their basic needs.


Supplier Consent

Resource Acquisition Workers use this form when they reach an agreement with a private provider of emergency services. It includes a rate sheet that describes the good and services that can be reimbursed and their maximum rates. The form is not a legal agreement.


ESS File

(Registration and Services Record)

Registration Unit Workers in reception centres use this form to register the identity, location and needs of people affected by an emergency. The form is only mandatory if an evacuee wants to be referred to the services of a private provider.


ESS Follow-up Card

Documentation Unit Workers use this card to indicate that an ESS File (above) needs to be followed-up.


ESS Out Card

Documentation Unit Workers in reception centres use this when a completed ESS File (above) is taken from the master file.


Change of Information Form

Registration Unit Workers in reception centres use this form to update information of people who have already registered.


Health Canada Inquiry Card

Inquiry Unit Workers at reception centres complete this card when members of the public inquire about relatives living in the disaster area. If a match is made, the information is provided to the public by the reception centre or a central registry if applicable.

HC/SC 3090