Hello Tatiana

I am not familiar with the assessment, but this site (p.78, appendix C) has a survey form; however, I don't know if this is what you want:

http://www.neonoregon.org/wp-content/uploads/images/2010-Final-Assessment-Report.pdf

This site has an email address (also a telephone number) that could help you: 

http://www.ohsu.edu/xd/outreach/oregon-rural-health/resources/community-needs-assessment.cfm

I hope you find what you need; good luck with your project.

Very best wishes,

Mary

Thank you Mary! Extremely helpful!