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* 1. Do you have any of the following in your residence that are operational? (Check all that apply)

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* 2. Do you have a current home fire escape plan and do you practice it?

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* 3. Has anyone in your household had any recent medical training (past 1-2 years) or hold any current medical certifications or licenses? (check all that apply)

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* 4. Are you prepared to be without water, electricity, heat and food for up to 72 hours in the event of a disaster?

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* 5. Which of the following describes your home's heat source(s) (check all that apply)

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* 6. Is your house address clearly visible on your house or driveway during daylight and in the dark?

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* 7. Please check the box on how you would rate (or how you perceive) the effectiveness of Pilot Rock Fire District in the following areas.

  Excellent Good Average Below Average Poor Don't know
Response to fire emergencies
Response to medical emergencies
Response to other emergencies (technical rescue, hazmat)
Public education about fire safety
Professionalism of Fire District personnel
Cost-effectiveness
Public relations

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* 8. Have you interacted with Fire District personnel in the past year?

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* 9. If YES to question #8 above which one of the following would you classify your interaction? (Please check all that apply)

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* 10. Do you think the Fire District needs to improve its customer service?

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* 11. Which of the following emergency services do you think the Fire District provides? (check all that apply)

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* 12. Which emergency service do you think is most valuable to the community?

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* 13. Which of the following non-emergency services do you think the Fire District provides? (check all that apply)

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* 14. Which non-emergency service do you think is most valuable to your community?

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