Are You Red Cross Ready? Survey

1. I have an Emergency Supplies Kit:
If "yes", please move to question 2.
If "no", please move to question 3.

I have an Emergency Supplies Kit: If "yes", please move to question 2. If "no", please move to question 3. Yes

2. My Emergency Supplies Kit has the following items (check all that apply):

My Emergency Supplies Kit has the following items (check all that apply): Water

Food

Flashlight

Whistle

First Aid Kit

Medications

Personal Hygiene Items

Copies of Personal Documents

Emergency Contact Information

Entertainment Items

Maps

Cash

None of the above

3. I have made an emergency plan with my family:
If "yes", please move to question 4.
If "no", please move to question 5.

I have made an emergency plan with my family: If "yes", please move to question 4. If "no", please move to question 5. Yes

4. My Family Emergency Plan includes:

My Family Emergency Plan includes: An emergency meeting place just outside my home

An emergency meeting place outside my neighborhood

An out of state emergency ocntact

A plan for my pets

Responsibilities for each member of the household

None of the above

5. I have the following amount of water stored:

I have the following amount of water stored: No water

Some water

At least one gallon for each member of my household

At least one gallon of water per day for three days for each member of my household

6. I have included my pet(s) in my emergency plan:

I have included my pet(s) in my emergency plan: Yes

I don't have a pet

7. I have the following contact information somewhere highly visible in case of emergency:

I have the following contact information somewhere highly visible in case of emergency: Personal Emergency Contacts

Doctor

Fire Department

Police Department

Ambulance

Poison Control

I do not have emergency contact information available

8. It would be simple and memorable for me to receive preparedness information from the following resource(s):

It would be simple and memorable for me to receive preparedness information from the following resource(s): Direct (email or phone)

Facebook / other social media

Preparedness websites (example: http://www.RedCrossLA.org)

Class or presentation

9. I would be most interested in receiving preparedness information on the following topic:

I would be most interested in receiving preparedness information on the following topic: Earthquakes

Fires

Flu

Kids

Pets

People with Disabilities

10. (Optional) I would like to be better prepared for a disaster. Please contact me with more information:

(Optional) I would like to be better prepared for a disaster. Please contact me with more information: Phone
Email
Interests

Are You Red Cross Ready?
Exit this survey

1. How prepared am I?

1. I have an Emergency Supplies Kit:
If "yes", please move to question 2.
If "no", please move to question 3.

2. My Emergency Supplies Kit has the following items (check all that apply):

3. I have made an emergency plan with my family:
If "yes", please move to question 4.
If "no", please move to question 5.

4. My Family Emergency Plan includes:

5. I have the following amount of water stored:

6. I have included my pet(s) in my emergency plan:

7. I have the following contact information somewhere highly visible in case of emergency:

8. It would be simple and memorable for me to receive preparedness information from the following resource(s):

9. I would be most interested in receiving preparedness information on the following topic:

10. (Optional) I would like to be better prepared for a disaster. Please contact me with more information:

Are You Red Cross Ready?Exit this survey

1. How prepared am I?

1. I have an Emergency Supplies Kit:If "yes", please move to question 2.If "no", please move to question 3.

2. My Emergency Supplies Kit has the following items (check all that apply):

3. I have made an emergency plan with my family:If "yes", please move to question 4.If "no", please move to question 5.

4. My Family Emergency Plan includes:

5. I have the following amount of water stored:

6. I have included my pet(s) in my emergency plan:

7. I have the following contact information somewhere highly visible in case of emergency:

8. It would be simple and memorable for me to receive preparedness information from the following resource(s):

9. I would be most interested in receiving preparedness information on the following topic:

10. (Optional) I would like to be better prepared for a disaster. Please contact me with more information:

Are You Red Cross Ready?
Exit this survey

1. I have an Emergency Supplies Kit:
If "yes", please move to question 2.
If "no", please move to question 3.

3. I have made an emergency plan with my family:
If "yes", please move to question 4.
If "no", please move to question 5.