Rural Municipality of Miltonvale Park Emergency Measures Questionnaire 2020

Information about your Household

The Rural Municipality of Miltonvale Park is updating its Emergency Measures Plan to protect health, safety and the welfare of the community members, and minimize damage to property and the environment. The information gathered will be used to update the current plan and identify those who may be vulnerable or who may be able to help their neighbours during an emergency. All information gathered is confidential and will only be used for emergency measures planning purposes. The survey has seven questions. Thank you for taking your time to share your answers with the Miltonvale Park EMO committee. This survey is designed to gather information from residents who live in North Milton, Springvale and Milton Station, (which includes Sleepy Hollow and South Milton) PEI.

Question Title

* 1. Contact Information for us to use in the event of an emergency (e.g. to share information and updates)

Civic Address

Names of Resident(s)

Home Phone Number

Cell Phone Number(s)

Work Phone Number(s)

Email Address

Email Address (person 2)

Email Address (person 3)

Twitter addresses

Question Title

* 2. Is there a separate apartment in this house?

Yes

Question Title

* 3. Do you think your household might need special attention in an emergency?

	Yes	No
Do you have young children?	Do you have young children? Yes	Do you have young children? No
Details
Does someone in your house have mobility, health or disability issues?	Does someone in your house have mobility, health or disability issues? Yes	Does someone in your house have mobility, health or disability issues? No
Details
Is it likely that you would need transportation in an emergency?	Is it likely that you would need transportation in an emergency? Yes	Is it likely that you would need transportation in an emergency? No
Details
Does your ONLY source of heat need electricity? If the power goes out, will you be cold?	Does your ONLY source of heat need electricity? If the power goes out, will you be cold? Yes	Does your ONLY source of heat need electricity? If the power goes out, will you be cold? No
Details
Do you store significant amounts of hazardous or dangerous goods - such as propane, fuels or fertilizer?	Do you store significant amounts of hazardous or dangerous goods - such as propane, fuels or fertilizer? Yes	Do you store significant amounts of hazardous or dangerous goods - such as propane, fuels or fertilizer? No
Details
Do you have pets?	Do you have pets? Yes	Do you have pets? No
Details
Do you have livestock?	Do you have livestock? Yes	Do you have livestock? No
Details
If an evacuation was necessary, would you likely need a place to stay? For instance - no nearby friends or relatives who could host you outside an evacuation zone.	If an evacuation was necessary, would you likely need a place to stay? For instance - no nearby friends or relatives who could host you outside an evacuation zone. Yes	If an evacuation was necessary, would you likely need a place to stay? For instance - no nearby friends or relatives who could host you outside an evacuation zone. No
Details
Are there other issues you can think of that might make you vulnerable in an emergency?	Are there other issues you can think of that might make you vulnerable in an emergency? Yes	Are there other issues you can think of that might make you vulnerable in an emergency? No
Details

Question Title

* 4. May we send municipal notices to your email addresses?

Yes