Directions: Use this checklist to organize your emergency preparations. It should be used in conjunction with the Emergency Medical and Medication Tracking forms also found on this site. Be sure to review this form every couple of months to keep it current.
| The Basics |
Yes |
No |
Comments |
| Do I know the most important disaster issues for the area where I live (earthquakes, floods, tornados)? |
 |
|
 |
| Do I know how I should respond to a disaster that might strike with little or no warning? |
|
|
|
| Do I know the recommended evacuation route if there were an evacuation order? What are my transportation options? Where is the nearest shelter? |
|
|
|
| Do I know where the shut-off valves are for my home?s utilities and how to turn them off? If any special tools are needed, where are they located? |
|
|
|
| Do I have an emergency contact person who lives out of the area? Do my relatives or close friends know who this person is? |
|
|
|
| Do I know my neighbors in case we need to help each other in an emergency? |
|
|
|
| If I am receiving home health services, have I discussed emergency procedures with the provider? |
|
|
|
If I have any special needs, do I have a plan for dealing with them in an emergency?
- Mobility
- Medical equipment requiring electric power
- Incontinence supplies
- Other:
|
|
|
|
| If I live in a senior community, am I familiar with its emergency planning and procedures? |
|
|
|
