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1. Do you live in the City of Bothell?

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2. Which neighborhood or area of Bothell do you live in?

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3. Type of Household?

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4. How many people living in your household are: (Select the number of members next to their age group):

  Number
Less than 2 years old
2-17 years old
18-64 years old
More than 65 years old
Prefer not to say

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5. How old are you?

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6. What is the main language spoken in your household?

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7. Do you or does any member of your household need any of the following? (Check all that apply)

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8. What is your household’s main source of information about a disaster or emergency event?

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9. Does your household have any of the following emergency plans? (Check all that apply)

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10. Do you have pets?

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11. If yes, do you have the following for your pets: (Check all that apply)

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12. What natural disasters do you think might affect our community?

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13. Do you know what your personal actions need to be in the event of a natural disaster?

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14. What would be the main reason that may prevent your household from evacuating if asked to do so?

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15. Do you have smoke alarms in working condition installed in your house?

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16. Do you have a fire extinguisher in working condition?

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17. Do you know how to use a fire extinguisher?

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18. What would your household want to know more about to be better prepared for an emergency/disaster?

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