NVSC Survey of People with Disabilities
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1. Disaster Preparedness Survey

 
The Nebraska Volunteer Service Commission (NVSC) has been named the Lead Agency in Nebraska for disaster preparedness and response activities for individuals with disabilities by the Nebraska Emergency Management Agency. The NVSC and its Citizen Corps Councils along with individuals with disabilities are working together to prepare for responses to a disaster. Your response to this survey will help us to develop a deeper understanding regarding the possible impact a disaster might have on persons with disabilities, and give us the insight we need to help us develop a Toolkit for communities to use to prepare incase of a disaster.

Thank you for your assistance.
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1. What county do you live in?

2. Do you have a written personal plan in case of an emergency and/or disaster?

3. Do you have a personal emergency/disaster preparedness kit?

4. If no to either question 2 or 3 would you be interested in participating in a short training and/or receiving assistance in developing a personal preparedness plan/kit?

5. If yes to question 2 or 3, what does your personal emergency/disaster preparedness plan and kit include? (Please check all that apply)

6. Do you take part in any formal community efforts supporting disaster preparedness?

7. Do you know if your community has a disaster preparedness plan that includes a plan to serve people with disabilities?

8. Would you be interested in being involved in community planning efforts for disaster preparedness?

9. Have you taken part in an emergency disaster simulation or exercise either in your community, housing unit, school or business?

10. Do you have a disability that would make it difficult for you to get to safety if there were an emergency or disaster?

11. Is your disability visible? In other words, could emergency personal easily recognize that you have a disability?

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12. What is the nature of your disability?

13. What kinds of adaptive devices do you use to accommodate your disability?

14. Do you know where the local shelters are located that have the ability to house people with special needs or disabilities?

15. What type of special needs accomodations would you require at a shelter?

16. If there would be an opportunity to pre-register with a special needs shelter, would you do so?

17. Would you volunteer to sign up on a confidential registry that identifies individuals with disabilities and their special needs (used only in case of emergency or disaster)if one were available in your community?

18. Would you go to a shelter to avoid being alone during an emergency and/or disaster in your community?

19. Would you be willing to participate in, observe, or evaluate disaster exercises in your community?

20. Do you know what evacuation route to use if you are required to leave your neighborhood?

21. Have you lived in a community where a community disaster or emergency has occured within the last ten years?

22. If yes to 28 - what kind of disaster or emergency was it?

23. If yes, did you have to be evacuated?

24. Were accommodations made for you and your family?

25. If you were evacuated - what personal challenges did you face? (Check all that apply)

26. Please provide any comments or suggestions that you think would assist in the development of disaster preparedness planning for people with disabilities.

Thank you for taking the time to respond to this survey. All the answers will be compiled into a report. However personal information collected will not be shared.

Questions 27-39 are for collection of demographics only and or optional. Contact information is used to contact you for training opportunities.
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27. Please provide your contact information. All information will be kept confidential.

28. Gender

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29. Race

30. Age

31. Marital Status

32. Living Arrangement

33. Type of Housing

34. What is your primary language?

35. Level of education

36. Do you have a disability that would make it difficult for you to get to safety if there were an emergency or disaster?

37.
Is your disability visible? In other words, could emergency personal easily recognize that you have a disability?

38. What is the nature of your disability?

39. What kinds of adaptive devices do you need to accommodate your disability?