I live in a/n: 

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* 2. I live in a/n: 

In my home, I have supplies (water, food, medical, shelter) for all the members of my household to include pets:

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* 3. In my home, I have supplies (water, food, medical, shelter) for all the members of my household to include pets:

In my vehicle/s, I have emergency supplies (water,food, medical, clothing) to sustain myself for:

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* 4. In my vehicle/s, I have emergency supplies (water,food, medical, clothing) to sustain myself for:

I have an established emergency plan for my household (spouse/partner/significant other, minor children or other dependents, pets), and all members know and understand the plan.

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* 5. I have an established emergency plan for my household (spouse/partner/significant other, minor children or other dependents, pets), and all members know and understand the plan.

The neighborhood I live in has completed the Map Your Neighborhood program.

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* 6. The neighborhood I live in has completed the Map Your Neighborhood program.

I have the following medical skills/certifications (check all that apply):

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* 7. I have the following medical skills/certifications (check all that apply):

During a typical week, I am off-island:

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* 8. During a typical week, I am off-island:

During a typical week, my spouse/partner/significant other is off-island:

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* 9. During a typical week, my spouse/partner/significant other is off-island:

I have emergency supplies in my office to sustain myself for:

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* 10. I have emergency supplies in my office to sustain myself for:

The company I work for has shared their emergency response plan with me and identified my role, if any.

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* 11. The company I work for has shared their emergency response plan with me and identified my role, if any.

The company I work for has emergency supplies on hand for me.

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* 12. The company I work for has emergency supplies on hand for me.

I have a minor child/ren who remain/s on-island while I am off-island during the week. 

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* 13. I have a minor child/ren who remain/s on-island while I am off-island during the week. 

I am responsible for non-minor vulnerable dependent/s who remain on-island while I am off-island during the week.

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* 14. I am responsible for non-minor vulnerable dependent/s who remain on-island while I am off-island during the week.

I have identified trusted, alternate care providers for my child or vulnerable dependent in  the event of an emergency or disaster.

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* 15. I have identified trusted, alternate care providers for my child or vulnerable dependent in  the event of an emergency or disaster.

I know the emergency plan for the organization my child/ren or vulnerable dependent/s attend during the week. (Options include: school, after-school program, day care, care facility, etc.)

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* 16. I know the emergency plan for the organization my child/ren or vulnerable dependent/s attend during the week. (Options include: school, after-school program, day care, care facility, etc.)

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