Home Emergency Preparedness Assessment Form
Evaluate your household's readiness for emergencies by answering the following questions.
How many people live in your household?
*
Does your household have an emergency supply kit with at least 3 days' worth of food and water for everyone?
*
Yes
Partially (some supplies, but not complete)
No
How would you rate your household's overall emergency preparedness?
*
1
2
3
4
5
Which of the following emergency supplies do you currently have and are accessible?
*
First aid kit
Flashlights with batteries
Portable radio
Extra medications
Blankets
Manual can opener
Other
Does your household have a clear emergency communication plan?
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Yes, all members know the plan
Somewhat, but not everyone is informed
No, we do not have a plan
Have you identified at least two evacuation routes from your home?
*
Yes, and practiced them
Identified but not practiced
No
Which backup utilities do you have available for emergencies?
*
Backup generator
Battery power supply
Solar power
None
Special Needs Planning
*
Rows
Plan in place
Needs identified
Children
1
2
Elderly
3
4
Individuals with disabilities
5
6
Pets
7
8
Do you have copies of important documents (IDs, insurance, medical info) stored safely and accessibly?
*
Yes, both physical and digital copies
Only physical copies
Only digital copies
No
What is your biggest concern or area needing improvement in your emergency preparedness?
Submit Assessment
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