* 1. My home is located in the following area

* 2. My household includes: (Check all that apply)

* 3. How do you primarily obtain local, state, and national news and information?

* 4. How do you primarily receive your local weather forecast information?

* 5. What is the fastest and surest way of delivering severe weather or disaster news and updates to you?

* 6. Does your family have a Family Emergency Plan?

* 7. Does your Family Emergency Plan include: (Check all that apply)

* 8. Does your or your child's school have an Emergency Plan for disaster?

* 9. Does your workplace have an Emergency Plan for disaster?

* 10. Do you and all other members of your family, including your pets have a GO KIT, Get Away Bag or similar item? (Check all that apply)

* 11. I am aware of the risk and hazard to all local disasters, such as, earthquake, tsunami, severe weather, flooding,
tornado and wildfire.

* 12. I expect an Earthquake to affect my community in the next:

* 13. I expect a Tsunami to affect my community in the next:

* 14. I expect Flooding to affect my community in the next:

* 15. If a disaster situation is imminent, my expectation is, I will recieve warning and instructions from the following: (Check all that apply)

* 16. If you received conflicting information about an approaching disaster event, who would you contact in order to obtain the correct information you will need?

* 17. If a disaster situation was imminent, would you evacuate your home if warned to do so, by official authorities?

* 18. If you had a 10 hour advance warning of the need to evacuate your home, how long would you expect it to take, to prepare and leave your home, once you receive the initial evacuation warning?

* 19. If you were to evacuate following a warning given by local authorities, would you bring your pet(s) with you?

* 20. If you were to evacuate following an order given by local authorities, where would you most likely go?

* 21. What modes of transportation are available to you in the event you have to evacuate from your home? (Check all that apply)

* 22. I expect emergency response agencies to assist me if I must evacuate my home.

* 23. If my County was impacted by a significant disaster event lasting multiple days, I expect Federal and State Response Agencies, including FEMA and the Red Cross, to respond within:

* 24. If my County was impacted by a significant disaster event lasting multiple days, I expect Local, City and County Response Agencies to respond within:

* 25. In a significant disaster event lasting multiple days, who would you seek out to obtain food or shelter assistance?

* 26. Have you signed up for the Emergency Alert and Notification System in your county?

* 27. Do you have a NOAA All Hazards "Alert" Weather Radio?

* 28. Which news headline would likely interest you enough to read the associated article?

* 29. Please indicate if you would like more information on any of the following:

* 30. Do you have suggestions, comments, questions or constructive criticism? Please write your comments or concerns here. (If you desire a reply, please leave your name, email, and phone number).

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