Community Preparedness Survey Name First Last Email Does your household have an emergency evacuation plan?YesNoDo you have an emergency kit prepared?YesNoAre you aware of the chemical hazard risks in your area?YesNoAre you aware of any Emergency Shelter Plans in your area?YesNoAre you familiar with the emergency plans for your work place?YesNoDo you have any pets ?YesNoDoes our emergency plans include plans for the well-being of your pet?YesNoHow are you typically informed about hazardous weather conditions (i.e. tornado)?How prepared would you rate your household f or an extended power outage (more than 24hr)?Preparations made and a detailed plan known by all residentsPreparations made and a general plan known by all residentsSome Preparations MadeNo Preparations at allIf the need arose, how comfortable would you feel using a fire extinguisher?Very ComfortableFairly ComfortableBarely ComfortableI don't know how to use a fire extinguisherHow safe and disaster ready do you feel your community is?If your vehicle broke down on the road in winter, would you be able to protect yourself if help was not able to reach you for more than an hour?YesNoHow can we help you be more prepared?What limitations would you and your family face in an emergency?What community preparedness resources would be beneficial to see made available? This iframe contains the logic required to handle Ajax powered Gravity Forms.