This survey is being used by the IL-IN-WI Regional Catastrophic Planning Team (RCPT) to understand your household’s considerations of and actions towards being prepared for a natural disaster or emergency. The survey helps us assess household preparedness for disasters throughout certain regions of IL-IN-WI and could help improve governmental, non-governmental and private coordination of preparedness and risk reduction activities within your community. We appreciate you taking a few minutes to complete this survey.

* 1. Please provide your name, County and zip code.

* 2. What disasters or emergencies are currently the highest priority to you and your household? Will you please rank the following, where 10 indicates high priority and 1 indicates low priority.

  1 2 3 4 5 6 7 8 9 10
Extreme Heat
Food Borne Illness
Pandemic Influenza
Winter Storm
Chemical or Hazardous Material Incident
Cyber Crime
Nuclear Power Plant Emergency
School or Workplace Violence
Terrorist Attack
Radiological Attack

* 3. Have there been any disasters in the news that have changed how you ranked the previous list of disasters? If so, what were those disasters?

* 4. In the last 3 months, did you seek additional information about being prepared? If so, what motivated you to seek additional preparedness information?

* 5. In the last 3 months, where did you go for additional preparedness information?

* 6. Did the website or other information source provide you with the information you were looking for?

* 7. Did you take any steps to be prepared in the last 3 months? If so, what steps did you take?

Additional information that will help you and your family increase preparedness can be found on the next page, and by visiting