How Can We Help You Prepare?
1.
Do you have a disaster preparedness plan?
Yes
No
2.
If you answered yes to Q1: Is the plan understood and accesible to all in your care?
Yes
No
None of the above
3.
If you answered No to Q1 or Q2: What is the main barrier/ barriers you face preventing you from having a written accessible plan?
Lack of Resources
Lack of Time
Not having the information to properly make one
Unique needs
Other (please specify)
4.
Do you have or provide care for someone with special health care needs or other unique needs?
Yes
No
Other (please specify)
5.
What are the special health care or unique needs that should that you or someone in your care has?
6.
What kind of guide would help you and those you care for?