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* 1. In the past FIVE years, or since you moved to  this jurisdiction if less, have you or someone in your household experienced a natural disaster such as an earthquake, severe windstorm, flood, wildfire, tornado or other type of natural hazard?

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* 2. Which of these natural hazards have you or someone in your household experienced?

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* 3. Have you ever received information about how to make your household and home safer from natural disasters?

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* 4. Where did you last receive information about how to make your household and home safer from natural disaster?

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* 5. What is the most effective way for you to receive information about how to make your household and home safer from natural disasters?

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* 6. In the following list, please check those activities that you have done in your household, plan to do in the near future, have not done, or are unable to do.

  Have done Plan to do Unable to do
Attended meetings or received written information on natural disasters or emergency preparedness.
Talked with members in your household about what to do in case of a natural disaster or emergency?
Developed a “household/Family Emergency Plan”?
Prepared a “Disaster Supply Kit” (stored extra food, water, batteries, or other emergency supplies)?
In the last year, has anyone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR)

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* 7. What steps, if any, have you or someone in your household taken to prepare for a natural disaster? (Check all that apply)

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* 8. Does your household have insurance coverage for FLOOD events?

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* 9. Does your household have insurance for earthquake damage?

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* 10. Did you consider the possible occurrence of a natural hazard when you bought / moved to your current home?

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* 11. What non-structural modifications have you made to your home to protect it against earthquakes?

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* 12. What structural modifications have you made to your home to protect against hazard damage?

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* 13. Which of the following incentives would motivate you to take additional steps to protect your family and home from natural disasters?

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* 14. Do you currently own or rent your home?

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* 15. Is your current home one of the following?

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* 16. Do you have immediate access to a saferoom in your home?

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* 17. Please enter your zip code.

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