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* 1. How concerned are you about the following Hazards in your community?

  Not Concerned Somewhat Concerned Moderately Concerned Very Concerned
Avalanche
Climate Change
Dam Failure
Drought
Earthquake
Flooding
Landslides/Debris Flows
Levee Failure
Severe Weather - Extreme Heat
Severe Weather - Wind
Severe Weather - Winter Storms and Extreme Cold
Land Subsidence (Sinkhole)
Volcano
Wildfire

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* 2. What is the best way for you to receive information about how to make your home and the people in your home safer from natural disasters?

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* 3. How concerned are you that a natural disaster could threaten your home?

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* 4. In the following List, Please check those activities that you or someone in your household, Have Done, Plan To Do in the near future, have Not Done, or are Unable To Do. (Please check one answer per activity).

  Have Done Plan To Do Not Done Unable To Do
Attended meetings or received written information on natural disasters or emergency preparedness.
Talked with family members about what to do in case of a disaster or emergency. 
Developed a “Household/Family Emergency Plan” in order to decide what everyone would do in the event of a disaster.
Prepared a “Disaster Supply Kit” (extra food, water, batteries, medications, first aid, and other emergency supplies).
In the last year, has someone in your household been trained in First Aid or Cardio-Pulmonary Resuscitation (CPR).

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* 5. Natural disasters can have a significant impact on a community, but planning for these events can help lessen the impact. The following statements will help us determine community priorities in planning for these hazards. Please tell us how important each one is to you?

  Very Important Somewhat Important Neutral Not As Important Not Important
Protecting private property
Protecting critical facilities (hospitals, transportation networks, fire stations)
Protecting natural environment
Protecting historical / cultural landmarks
Protecting and reducing damage to utilities
Preventing development in hazardous areas
Promoting cooperation among public agencies, citizens, non-profit organizations and businesses
Strengthening emergency services (police, fire, ambulance)

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* 6. Please provide your zip code

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* 7. Your Community Name or Location

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* 8. Do you live within City Limits?

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* 9. Do you own or rent your home?

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* 10. Do you have internet access at your home?

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