Town of Ross DMA Survey
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1. Hazards Mitigation and Preparedness Questionnaire

Town of Ross
Disaster Mitigation Planning Project 2010

This questionnaire is intended to help the Town's hazard mitigation planning project by identifying residents' concerns about natural and human-caused hazards and the community's needs in reducing risk and loss from such hazards. The specific questions are designed to comply with the Federal Emergency Management Agency (FEMA) requirements for local hazard mitigation plans. For optimal results it will be most effective if the questionnaire is completed by an adult--preferably the homeowner or the head of the household. Please take a few moments to complete this questionnaire. All individual responses are strictly confidential, and are for planning purposes only. Thank you for your attention to this planning effort.

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1. Zipcode of your residence:

Zipcode of your residence: ZIP:

2. Internet Access?

Internet Access? Yes

3. Do you

Do you Own

Rent

Other

4. How concerned are you about the following disasters affecting your community?

	Not Concerned	Somewhat Concerned	Moderately Concerned	Very Concerned
Floods	*How concerned are you about the following disasters affecting your community? Floods Not Concerned	Floods Somewhat Concerned	Floods Moderately Concerned	Floods Very Concerned
Fire	Fire Not Concerned	Fire Somewhat Concerned	Fire Moderately Concerned	Fire Very Concerned
Landslide	Landslide Not Concerned	Landslide Somewhat Concerned	Landslide Moderately Concerned	Landslide Very Concerned
Earthquake	Earthquake Not Concerned	Earthquake Somewhat Concerned	Earthquake Moderately Concerned	Earthquake Very Concerned
Telecommunications Failure	Telecommunications Failure Not Concerned	Telecommunications Failure Somewhat Concerned	Telecommunications Failure Moderately Concerned	Telecommunications Failure Very Concerned
Agricultural	Agricultural Not Concerned	Agricultural Somewhat Concerned	Agricultural Moderately Concerned	Agricultural Very Concerned
Severe Weather	Severe Weather Not Concerned	Severe Weather Somewhat Concerned	Severe Weather Moderately Concerned	Severe Weather Very Concerned
Biological/Plant/Animal	Biological/Plant/Animal Not Concerned	Biological/Plant/Animal Somewhat Concerned	Biological/Plant/Animal Moderately Concerned	Biological/Plant/Animal Very Concerned
Explosions	Explosions Not Concerned	Explosions Somewhat Concerned	Explosions Moderately Concerned	Explosions Very Concerned
Utility Interruption	Utility Interruption Not Concerned	Utility Interruption Somewhat Concerned	Utility Interruption Moderately Concerned	Utility Interruption Very Concerned
Terrorism	Terrorism Not Concerned	Terrorism Somewhat Concerned	Terrorism Moderately Concerned	Terrorism Very Concerned
Radiation	Radiation Not Concerned	Radiation Somewhat Concerned	Radiation Moderately Concerned	Radiation Very Concerned
Dam Failure	Dam Failure Not Concerned	Dam Failure Somewhat Concerned	Dam Failure Moderately Concerned	Dam Failure Very Concerned
Economic Disruption	Economic Disruption Not Concerned	Economic Disruption Somewhat Concerned	Economic Disruption Moderately Concerned	Economic Disruption Very Concerned
Special Events	Special Events Not Concerned	Special Events Somewhat Concerned	Special Events Moderately Concerned	Special Events Very Concerned
Health Alert/Epidemic	Health Alert/Epidemic Not Concerned	Health Alert/Epidemic Somewhat Concerned	Health Alert/Epidemic Moderately Concerned	Health Alert/Epidemic Very Concerned
Transportation Services	Transportation Services Not Concerned	Transportation Services Somewhat Concerned	Transportation Services Moderately Concerned	Transportation Services Very Concerned
Water/Waste Water Loss	Water/Waste Water Loss Not Concerned	Water/Waste Water Loss Somewhat Concerned	Water/Waste Water Loss Moderately Concerned	Water/Waste Water Loss Very Concerned

5. What is the most effective way for you to receive information about how to make your household and home safer from natural disasters? (Please check all that apply.)

What is the most effective way for you to receive information about how to make your household and home safer from natural disasters? (Please check all that apply.) Newspaper

Television news

Television ads

Radio news

Radio ads

Schools

Town Council Meetings

Mail

Fire Department

Internet

Fact sheet/brochure

Church/religious organization

Employer

Public meetings

Utility Bills

Post Office

6. In the following list, please check those activities that you:

	Have done	Plan to do	Not done	Unable to do
Attended meetings or received written information on natural disasters or emergency preparedness?	*In the following list, please check those activities that you: Attended meetings or received written information on natural disasters or emergency preparedness? Have done	Attended meetings or received written information on natural disasters or emergency preparedness? Plan to do	Attended meetings or received written information on natural disasters or emergency preparedness? Not done	Attended meetings or received written information on natural disasters or emergency preparedness? Unable to do
Talked with family members about what to do in case of a disaster or emergency?	Talked with family members about what to do in case of a disaster or emergency? Have done	Talked with family members about what to do in case of a disaster or emergency? Plan to do	Talked with family members about what to do in case of a disaster or emergency? Not done	Talked with family members about what to do in case of a disaster or emergency? Unable to do
Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster?	Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster? Have done	Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster? Plan to do	Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster? Not done	Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster? Unable to do
Prepared a “Disaster Supply Kit” (extra food, water, medications, batteries, first aid items and other emergency supplies)?	Prepared a “Disaster Supply Kit” (extra food, water, medications, batteries, first aid items and other emergency supplies)? Have done	Prepared a “Disaster Supply Kit” (extra food, water, medications, batteries, first aid items and other emergency supplies)? Plan to do	Prepared a “Disaster Supply Kit” (extra food, water, medications, batteries, first aid items and other emergency supplies)? Not done	Prepared a “Disaster Supply Kit” (extra food, water, medications, batteries, first aid items and other emergency supplies)? Unable to do
In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)?	In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)? Have done	In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)? Plan to do	In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)? Not done	In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)? Unable to do

7. Building a disaster supply kit, receiving First Aid training and developing a household/family emergency plan are all inexpensive activities that require a personal time commitment. How much time (per year) are you willing to spend on disaster/emergency preparedness? (Please check only one.)

Building a disaster supply kit, receiving First Aid training and developing a household/family emergency plan are all inexpensive activities that require a personal time commitment. How much time (per year) are you willing to spend on disaster/emergency preparedness? (Please check only one.) 0-1 hour

2-3 hours

4-7 hours

8-15 hours

16+ hours

Other (please specify)

8. Do you know how to shut off your (circle all that apply):

	Yes	No
Electricity	*Do you know how to shut off your (circle all that apply): Electricity Yes	Electricity No
Water	Water Yes	Water No
Gas	Gas Yes	Gas No

9. Is your home at risk of flooding or earthquake damage? If so please answer Question 10 below.

Is your home at risk of flooding or earthquake damage? If so please answer Question 10 below. Yes

10. Do you carry Flood Insurance?

Do you carry Flood Insurance? Yes

11. Do you carry Earthquake Insurance?

Do you carry Earthquake Insurance? Yes

12. Would you be willing to make your home more resistant to natural disasters?

Would you be willing to make your home more resistant to natural disasters? Yes

13. What nonstructural or structural modifications for earthquakes and floods have you made to your home?
(Please check all that apply.)

What nonstructural or structural modifications for earthquakes and floods have you made to your home? (Please check all that apply.) Anchor bookcases, cabinets to wall

Secure home to foundation

Secure water heater to wall

Brace inside of cripple wall with sheathing

Install latches on drawers and cabinets

Brace unreinforced chimney

Fit gas appliances with flexible connections

Brace unreinforced masonry, concrete walls and foundations

None