Resident Evacuation Assessment Form
Evaluate your household's evacuation readiness and identify needs to ensure safety during emergencies. Please answer each question accurately to help assess preparedness.
How many people live in your household?
*
Does your household have an evacuation plan?
*
Yes
No
Not sure
How confident are you in your household's ability to evacuate quickly if needed?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which of the following best describes your household's access to transportation during an evacuation?
*
Personal vehicle available
Rely on public transportation
Assistance from friends/family
No transportation available
Does anyone in your household have mobility, medical, or other special needs that would affect evacuation?
*
Yes
No
How prepared is your household in the following areas?
*
Rows
Not at all
Somewhat
Mostly
Fully
Emergency supplies (food, water, medicine)
1
2
3
4
Important documents ready
5
6
7
8
Communication plan with family
9
10
11
12
Knowledge of evacuation routes
13
14
15
16
Where would your household go in case of an evacuation?
*
Please Select
Stay with friends/family
Public shelter
Hotel or similar accommodation
Other
How would you prefer to receive emergency evacuation instructions?
*
Phone call
Text message
Email
Local news/radio
Other
Do you have pets that would need to be evacuated with your household?
*
Yes
No
Please share any additional information or concerns regarding your household's evacuation needs.
Submit Assessment
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