Family Emergency Response Survey

by | May 4, 2021 | Featured, Safety & Emergencies | 0 comments

What If? Do You know What to do?

  • *Medical Emergency: What if….
    Your 3 year old is choking on a hot dog?
  • Accident: What if…
    Your neighbor cuts his foot using his lawn mower and is bleeding badly?
  • Missing Person: What if…
    The senior care home calls to tell you your father who has Alzheimer’s has disappeared?
  • Victim: What if…
    You’re walking to your car with shopping bags and a thief grabs your purse?
  • Fire: What if…
    The smoke alarm goes off at 3:00am, your kids are asleep upstairs?
  • Natural Disaster: What if…
    A category 5 hurricane with 155 winds is fast approching…do you evacuate or stay?
  • Terrorism: What if…
    Immediately after a special news bulletin warning about the threat of a terrorist attack,
    you hear multiple explosions and see a strange mist with an unusual odor?

Take the FREE EMERGENCY RESPONSE SURVEY FOR FAMILIES AND FIND OUT YOUR SCORE

Family Emergency Response Survey

"*" indicates required fields

First,

Each person should take the survey independently. Based on your own personal knowledge, without asking your spouse or anyone else in your household, answer the following questions. If you do not know the answer, check the question mark (?). If the question is not applicable, check the not applicable (NA) box. See scoring guide at end of survey.

Next,

Compare the results of your survey with the other people in your household. By combining all the scores together and figuring out the average, you will have your important family emergency profile.

Name*

PART 1: COMMUNICATION

In an emergency, can you contact the people or organizations listed below immediately:
Fire Department
Poison Control Center
Police Department
Hospital
Doctor
Ambulance
Pharmacist
Your Child's School
Spouse or Parents' Workplace
In an emergency, can you be reached by any of the following ASAP:
Cellphone
Social Media
Email
Walkie Talkie
Answering Service
Relative
Friend
Neighbor
Colleague
Employer

PART 2: PLANNING

Do you have any emergency plan for evacuation to the nearest shelter?
Do you have an emergency plan for evacuation to a designated place instead of a shelter?
Do you have an emergency plan for staying in and securing your house?
Does everyone in the family know the plan?
Do you know your official Civil Defense radio broadcast station?
Do you know your child's school emergency plan?
Do you know your workplace emergency plan?
If you are separated, do you have a plan to make contact?
Do you have an emergency plan while on vacation?
Does your family have an emergency phone tree?

PART 3: KNOWLEDGE & SKILLS

Does anyone in the family have the following knowledge or skill?
First Aid
CPR
Pet CPR
Use of AED
Water Safety
Survival Skills
Search & Rescue
Self-Defense Tactics
Shortwave Radio
Construction (electrical, carpentry, plumbing, etc.)

PART 4: RESOURCES

Do you have any of the following?
House Insurance
Cell Phone
Self-powered Radio
First Aid Kit
Fire Extinguisher
Smoke Detector
Disaster Supplies
Safety Ladder for Second Story
Security System
Portable Generator or Auto 12 Volt Adapter

Scoring Guide

Number of YES answers x 2 points =
Number of No answers x 0 points =
Number of ? answers x 1 points =
Number of NA answers x 2 points =

Total Points =

FAMILY EMERGENCY PROFILE

EXCELLENT: 96 – 100
VERY GOOD: 90 – 95
GOOD: 85 – 89
OK: 80 – 84

To receive a copy of your personal Emergency Response Survey for Families and/or to view the Emergency Response Survey for Businesses and the Emergency Response Survey for Schools click SUBMIT
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