Town of Petersham - Emergency Communications Questionnaire Survey

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5. What is your preferred method of contact?

Verizon Land Line

Matrix Land Line

Cell Phone

Satellite (Hughes.net, Starlink, etc.)

Text Message

Other (please specify)

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6. How many people are in your household?

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7. Do minor children reside in your home?

Yes

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8. If yes, what are their age ranges (select all that apply)

Infant (0 - 2)

Preschool (3 - 4)

Elementary (5 - 10)

Middle School (11 - 13)

High School (14 - 18)

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9. Are there any seniors (age 65 or older) living in your household?

Yes

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10. Does anyone in your household have a disability or long-term physical, mental, or sensory condition?

Yes

Prefer not to answer

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11. If yes, does this disability affect their ability to communicate? (Select all that apply)

Difficulty speaking

Difficulty hearing

Difficulty understanding others

Uses assistive communication (e.g., devices, interpreter)

Prefer not to answer

Other (please specify)

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12. What best describes your property?

Single Family Home

Multiple Family Home

Farm

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13. Do you currently have a generator or a backup battery system to support your property if there is a loss of power?

Yes

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14. How does your household communicate with neighbors and emergency personnel when there is no electricity or Internet?

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15. Does anyone in your household require specialized health equipment that requires electricity?

Yes

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16. Are you a farmer or gardener?

Yes

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17. If you answered yes to the previous question, please describe your communications needs during extreme weather events.

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18. Do you have animals on your property?

Cat(s)

Dog(s)

Livestock

Other (please specify)

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19. Do these animals require special care in an emergency?

Yes

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20. If you answered yes to the previous question, please describe their needs.

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21. Do you have a regular neighborhood organization or friends' group that meets regularly?

Yes

If yes, please provide the name of the group and the point of contact.

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22. Do you have expertise in amateure radio or other communications?

Yes

The Town of Petersham is currently enrolled in the CodeRed notification system that enables Public Safety personnel to notify residents and businesses by telephone, text message and email about emergencies and urgent alerts. If you are interested in signing up you can text 24639.

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23. Seconds can make the difference between life and death and drastically reduce property damage, particularly in emergencies like fires, medical incidents, and vehicle accidents. Would you consider enrolling in CodeRed?

Yes

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24. Would you like assistance in signing up for CodeRed

Yes

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25. Please provide the most ideal way to contact you during an emergency.

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26. Do you want to share any additional information on how to best serve Petersham during an emergency?

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27. Would you like to be notified about meetings regarding this program?

Yes

If you answered yes, how may we contact you?

Town of Petersham - Emergency Communications Questionnaire

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* 1. Contact Information

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* 2. Email Address

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* 3. Phone Number

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* 4. Address

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* 5. What is your preferred method of contact?

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* 6. How many people are in your household?

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* 7. Do minor children reside in your home?

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* 8. If yes, what are their age ranges (select all that apply)

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* 9. Are there any seniors (age 65 or older) living in your household?

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* 10. Does anyone in your household have a disability or long-term physical, mental, or sensory condition?

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* 11. If yes, does this disability affect their ability to communicate? (Select all that apply)

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* 12. What best describes your property?

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* 13. Do you currently have a generator or a backup battery system to support your property if there is a loss of power?

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* 14. How does your household communicate with neighbors and emergency personnel when there is no electricity or Internet?

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* 15. Does anyone in your household require specialized health equipment that requires electricity?

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* 16. Are you a farmer or gardener?

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* 17. If you answered yes to the previous question, please describe your communications needs during extreme weather events.

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* 18. Do you have animals on your property?

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* 19. Do these animals require special care in an emergency?

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* 20. If you answered yes to the previous question, please describe their needs.

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* 21. Do you have a regular neighborhood organization or friends' group that meets regularly?

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* 22. Do you have expertise in amateure radio or other communications?

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* 23. Seconds can make the difference between life and death and drastically reduce property damage, particularly in emergencies like fires, medical incidents, and vehicle accidents. Would you consider enrolling in CodeRed?

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* 24. Would you like assistance in signing up for CodeRed

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* 25. Please provide the most ideal way to contact you during an emergency.

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* 26. Do you want to share any additional information on how to best serve Petersham during an emergency?

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* 27. Would you like to be notified about meetings regarding this program?

1. Contact Information

2. Email Address

3. Phone Number

4. Address

5. What is your preferred method of contact?

6. How many people are in your household?

7. Do minor children reside in your home?

8. If yes, what are their age ranges (select all that apply)

9. Are there any seniors (age 65 or older) living in your household?

10. Does anyone in your household have a disability or long-term physical, mental, or sensory condition?

11. If yes, does this disability affect their ability to communicate? (Select all that apply)

12. What best describes your property?

13. Do you currently have a generator or a backup battery system to support your property if there is a loss of power?

14. How does your household communicate with neighbors and emergency personnel when there is no electricity or Internet?

15. Does anyone in your household require specialized health equipment that requires electricity?

16. Are you a farmer or gardener?

17. If you answered yes to the previous question, please describe your communications needs during extreme weather events.

18. Do you have animals on your property?

19. Do these animals require special care in an emergency?

20. If you answered yes to the previous question, please describe their needs.

21. Do you have a regular neighborhood organization or friends' group that meets regularly?

22. Do you have expertise in amateure radio or other communications?

23. Seconds can make the difference between life and death and drastically reduce property damage, particularly in emergencies like fires, medical incidents, and vehicle accidents. Would you consider enrolling in CodeRed?

24. Would you like assistance in signing up for CodeRed

25. Please provide the most ideal way to contact you during an emergency.

26. Do you want to share any additional information on how to best serve Petersham during an emergency?

27. Would you like to be notified about meetings regarding this program?