Free Emergency Preparedness Questionnaire

Please fill out the following information for our records. Your input is valuable to us.
Date
Please enter the date you are completing this form.
Name
Please enter your full name, including your middle name if applicable.
Please enter your email address for contact purposes.
Do you have a family communication plan for emergencies?
Yes
No
Have you received any emergency preparedness training?
Yes
No
Do you have an emergency plan in place?
Yes
No
Do you have an emergency preparedness kit?
Fully Stocked Kit
Partially Stocked Kit
No Kit
How often do you practice emergency drills?
Select the frequency that best describes your practice.
Additional Comments
Please share any additional information or suggestions about emergency preparedness.
Thank You!
Your participation in this survey helps us improve our emergency preparedness initiatives. Stay safe!
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