How Prepared are YOU? Survey

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1. Are you registered with NIXLE? (www.nixle.com)

Are you registered with NIXLE? (www.nixle.com) Yes

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2. Have you registered your cell phone for Rev911? (www.sbsheriff.org)

Have you registered your cell phone for Rev911? (www.sbsheriff.org) Yes

N/A - No cell phone

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3. Rank the following methods in order of effectiveness for disseminating emergency information? (Specifically what works best for YOU)

	First	Second	Third	Fourth	Fifth	Sixth	Seventh	Eighth	Ninth	Tenth	Eleventh
TV	*Rank the following methods in order of effectiveness for disseminating emergency information? (Specifically what works best for YOU) TV First	TV Second	TV Third	TV Fourth	TV Fifth	TV Sixth	TV Seventh	TV Eighth	TV Ninth	TV Tenth	TV Eleventh
Radio	Radio First	Radio Second	Radio Third	Radio Fourth	Radio Fifth	Radio Sixth	Radio Seventh	Radio Eighth	Radio Ninth	Radio Tenth	Radio Eleventh
Rev911	Rev911 First	Rev911 Second	Rev911 Third	Rev911 Fourth	Rev911 Fifth	Rev911 Sixth	Rev911 Seventh	Rev911 Eighth	Rev911 Ninth	Rev911 Tenth	Rev911 Eleventh
Text Message	Text Message First	Text Message Second	Text Message Third	Text Message Fourth	Text Message Fifth	Text Message Sixth	Text Message Seventh	Text Message Eighth	Text Message Ninth	Text Message Tenth	Text Message Eleventh
Email	Email First	Email Second	Email Third	Email Fourth	Email Fifth	Email Sixth	Email Seventh	Email Eighth	Email Ninth	Email Tenth	Email Eleventh
Twitter	Twitter First	Twitter Second	Twitter Third	Twitter Fourth	Twitter Fifth	Twitter Sixth	Twitter Seventh	Twitter Eighth	Twitter Ninth	Twitter Tenth	Twitter Eleventh
Facebook	Facebook First	Facebook Second	Facebook Third	Facebook Fourth	Facebook Fifth	Facebook Sixth	Facebook Seventh	Facebook Eighth	Facebook Ninth	Facebook Tenth	Facebook Eleventh
Local internet news/blog sites	Local internet news/blog sites First	Local internet news/blog sites Second	Local internet news/blog sites Third	Local internet news/blog sites Fourth	Local internet news/blog sites Fifth	Local internet news/blog sites Sixth	Local internet news/blog sites Seventh	Local internet news/blog sites Eighth	Local internet news/blog sites Ninth	Local internet news/blog sites Tenth	Local internet news/blog sites Eleventh
Newspaper	Newspaper First	Newspaper Second	Newspaper Third	Newspaper Fourth	Newspaper Fifth	Newspaper Sixth	Newspaper Seventh	Newspaper Eighth	Newspaper Ninth	Newspaper Tenth	Newspaper Eleventh
Neighborhood phone tree	Neighborhood phone tree First	Neighborhood phone tree Second	Neighborhood phone tree Third	Neighborhood phone tree Fourth	Neighborhood phone tree Fifth	Neighborhood phone tree Sixth	Neighborhood phone tree Seventh	Neighborhood phone tree Eighth	Neighborhood phone tree Ninth	Neighborhood phone tree Tenth	Neighborhood phone tree Eleventh
Door to door notification	Door to door notification First	Door to door notification Second	Door to door notification Third	Door to door notification Fourth	Door to door notification Fifth	Door to door notification Sixth	Door to door notification Seventh	Door to door notification Eighth	Door to door notification Ninth	Door to door notification Tenth	Door to door notification Eleventh

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4. Does your family have a disaster supply kit?

Does your family have a disaster supply kit? Yes

5. If yes, does your home disaster supply kit contain (Check all that apply.)

If yes, does your home disaster supply kit contain (Check all that apply.) 3-day supply of non-perishable food (and manual can opener)

3-day supply of bottled water (1 gallon per person per day)

5-day supply of non-perishable food (and manual can opener)

5-day supply of bottled water (1 gallon per person per day)

Extra clothing and sturdy shoes for all family members

Flashlight and extra batteries

First aid kit

Battery-powered radio

Wrench and other tools

Sleeping bag or bedding for household members

Important documents like copies of proof of identification, insurance policies, or financial records

Cash

Prescription and over-the-counter medications for family members

Extra pair of eyeglasses

Pet supplies – food, carrier, leash

Books and games for children

Other (please specify)

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6. Do you have a disaster supply kit in your vehicle(s)?

Do you have a disaster supply kit in your vehicle(s)? Yes

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7. Have you discussed your disaster plans with your family?

Have you discussed your disaster plans with your family? Yes

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8. Do you have an out of state contact?

Do you have an out of state contact? Yes

9. If you answered YES to question 8, do all your family members know who that out of state contact is?

If you answered YES to question 8, do all your family members know who that out of state contact is? Yes

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10. Do you know where your gas, electricity, and water valves are and how to operate them?

Do you know where your gas, electricity, and water valves are and how to operate them? Yes

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11. Do your family members know where your gas, electricity, and water valves are and how to operate them?

Do your family members know where your gas, electricity, and water valves are and how to operate them? Yes

12. Have you taken steps to prepare you home for earthquakes?

Have you taken steps to prepare you home for earthquakes? Bolted structure to foundation

Secured water heater

Secured refrigerator

Secured furnace

Secured gas appliances.

Anchored overhead light fixtures

Fastened shelves

Fastened mirrors

Fastened large pictures / frames

Secured tabletop items with earthquake putty

Other (please specify)

13. Have you taken any disaster preparedness training? (Check all that apply.)

Have you taken any disaster preparedness training? (Check all that apply.) CPR

First Aid

Some CERT

Completed a CERT program

MERRAG training

Other (please specify)

14. Are there any specific training sessions that are not already offered that you would like to see offered by MERRAG?

Are there any specific training sessions that are not already offered that you would like to see offered by MERRAG?

15. Thank you for completing our survey. Please provide the following information. This information will remain confidential and will not be shared.

Name (Last, First)

Thank you for completing our survey. Please provide the following information. This information will remain confidential and will not be shared. Name (Last, First)

How Prepared are YOU?
Exit this survey

1. Default Section

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1. Are you registered with NIXLE? (www.nixle.com)

*
2. Have you registered your cell phone for Rev911? (www.sbsheriff.org)

*
3. Rank the following methods in order of effectiveness for disseminating emergency information? (Specifically what works best for YOU)

*
4. Does your family have a disaster supply kit?

5. If yes, does your home disaster supply kit contain (Check all that apply.)

*
6. Do you have a disaster supply kit in your vehicle(s)?

*
7. Have you discussed your disaster plans with your family?

*
8. Do you have an out of state contact?

9. If you answered YES to question 8, do all your family members know who that out of state contact is?

*
10. Do you know where your gas, electricity, and water valves are and how to operate them?

*
11. Do your family members know where your gas, electricity, and water valves are and how to operate them?

12. Have you taken steps to prepare you home for earthquakes?

13. Have you taken any disaster preparedness training? (Check all that apply.)

14. Are there any specific training sessions that are not already offered that you would like to see offered by MERRAG?

15. Thank you for completing our survey. Please provide the following information. This information will remain confidential and will not be shared.

Name (Last, First)

16. E-Mail Address

17. Address

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18. Zip

How Prepared are YOU?Exit this survey

1. Default Section

*1. Are you registered with NIXLE? (www.nixle.com)

*2. Have you registered your cell phone for Rev911? (www.sbsheriff.org)

*3. Rank the following methods in order of effectiveness for disseminating emergency information? (Specifically what works best for YOU)

*4. Does your family have a disaster supply kit?

5. If yes, does your home disaster supply kit contain (Check all that apply.)

*6. Do you have a disaster supply kit in your vehicle(s)?

*7. Have you discussed your disaster plans with your family?

*8. Do you have an out of state contact?

9. If you answered YES to question 8, do all your family members know who that out of state contact is?

*10. Do you know where your gas, electricity, and water valves are and how to operate them?

*11. Do your family members know where your gas, electricity, and water valves are and how to operate them?

12. Have you taken steps to prepare you home for earthquakes?

13. Have you taken any disaster preparedness training? (Check all that apply.)

14. Are there any specific training sessions that are not already offered that you would like to see offered by MERRAG?

15. Thank you for completing our survey. Please provide the following information. This information will remain confidential and will not be shared.Name (Last, First)

16. E-Mail Address

17. Address

*18. Zip

How Prepared are YOU?
Exit this survey

*
1. Are you registered with NIXLE? (www.nixle.com)

*
2. Have you registered your cell phone for Rev911? (www.sbsheriff.org)

*
3. Rank the following methods in order of effectiveness for disseminating emergency information? (Specifically what works best for YOU)

*
4. Does your family have a disaster supply kit?

*
6. Do you have a disaster supply kit in your vehicle(s)?

*
7. Have you discussed your disaster plans with your family?

*
8. Do you have an out of state contact?

*
10. Do you know where your gas, electricity, and water valves are and how to operate them?

*
11. Do your family members know where your gas, electricity, and water valves are and how to operate them?

15. Thank you for completing our survey. Please provide the following information. This information will remain confidential and will not be shared.

Name (Last, First)

*
18. Zip