Emergency Evacuation Preparedness Survey Form
This survey assesses your readiness, awareness, and resources for emergency evacuation. Please answer all questions to help us understand current preparedness levels.
How familiar are you with your building's emergency evacuation procedures?
*
Very familiar
Somewhat familiar
Not familiar
Do you have an emergency evacuation kit prepared?
*
Yes, fully stocked
Partially prepared
No kit prepared
How confident are you in your ability to evacuate safely during an emergency?
*
1
2
3
4
5
Please rate your agreement with the following statements about emergency preparedness.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I know where the nearest emergency exits are located.
1
2
3
4
5
I have a plan to assist others if needed.
6
7
8
9
10
I understand the building's alarm signals.
11
12
13
14
15
Which of the following emergency supplies do you currently have available?
*
Flashlight with batteries
First aid kit
Bottled water
Non-perishable food
Whistle
None of the above
Other
How will you communicate with others during an emergency evacuation?
*
Mobile phone call
Text message
Two-way radio
Verbal communication
Other
Do you have any accessibility needs that should be considered during an evacuation?
*
No, I do not have accessibility needs
Yes, mobility assistance
Yes, visual assistance
Yes, hearing assistance
Other
Have you participated in an emergency evacuation drill in the past 12 months?
*
Yes, more than once
Yes, once
No
What challenges or concerns do you have about emergency evacuation procedures?
What improvements would you suggest to enhance emergency evacuation preparedness?
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