Community Preparedness Survey Name First Last Email Does your household have an emergency evacuation plan? Yes No Do you have an emergency kit prepared? Yes No Are you aware of the chemical hazard risks in your area? Yes No Are you aware of any Emergency Shelter Plans in your area? Yes No Are you familiar with the emergency plans for your work place? Yes No Do you have any pets ? Yes No Does our emergency plans include plans for the well-being of your pet? Yes No How 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 residents Preparations made and a general plan known by all residents Some Preparations Made No Preparations at all If the need arose, how comfortable would you feel using a fire extinguisher? Very Comfortable Fairly Comfortable Barely Comfortable I don't know how to use a fire extinguisher How 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? Yes No How 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?