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Emergency Preparedness 2020
1.
Do you live in the City of Bothell?
(Required.)
Yes
No, I live in... (please specify)
2.
Which neighborhood or area of Bothell do you live in?
3.
Type of Household?
Single family
Apartment
Condo
Manufactured Home
Other (please specify)
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
-- Select an option --
0
1
2
3
4
5
6
7
8
9
2-17 years old
-- Select an option --
0
1
2
3
4
5
6
7
8
9
18-64 years old
-- Select an option --
0
1
2
3
4
5
6
7
8
9
More than 65 years old
-- Select an option --
0
1
2
3
4
5
6
7
8
9
Prefer not to say
-- Select an option --
0
1
2
3
4
5
6
7
8
9
5.
How old are you?
Under 18
19-24
25-35
35-50
51-65
Older than 65
Prefer not to say
6.
What is the main language spoken in your household?
English
Spanish
Other (please specify)
7.
Do you or does any member of your household need any of the following? (Check all that apply)
Daily Medication (other than Birth Control or Vitamins)
Home Health Care
Oxygen Supply
Wheelchair/Cane/Walker
8.
What is your household’s main source of information about a disaster or emergency event?
Newspaper
TV
Radio
Internet/Online News
Friends/Family/Word of Mouth
Social Media
Text Message/Cell Phone Alert
Church/Place of Worship
Other (please specify)
9.
Does your household have any of the following emergency plans? (Check all that apply)
Household/Family Emergency Plan
Emergency communication plans
Copies of important documents in a safe location
Started or Completed an Emergency Supply Kit
Trained in CPR
Trained in First Aid
Trained in CERT (Community Emergency Response Team)
10.
Do you have pets?
Yes
No
11.
If yes, do you have the following for your pets: (Check all that apply)
Animal first aid kit
Copies of pet records
Pet emergency supply kit
12.
What natural disasters do you think might affect our community?
13.
Do you know what your personal actions need to be in the event of a natural disaster?
Yes
No
14.
What would be the main reason that may prevent your household from evacuating if asked to do so?
Lack of transportation
Concern about personal safety
Health problems
Lack of trust in public officials
Concern about leaving pets
Concern about leaving property
Concern about traffic jams
Nowhere to go
Inconvenient/expensive
No reason, would evacuate
Other (please specify)
15.
Do you have smoke alarms in working condition installed in your house?
Yes
No
16.
Do you have a fire extinguisher in working condition?
Yes
No
17.
Do you know how to use a fire extinguisher?
Yes
No
18.
What would your household want to know more about to be better prepared for an emergency/disaster?
Current Progress,
0 of 18 answered
