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* 1. In what community do you live? Or what organization do you represent? 

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* 2. Please rank these natural hazards from which you think would cause the greatest harm to people and property in your community to least harm or damage.

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* 3. Why did you choose these hazards? Why do they cause the greatest concern to you? How have these hazards impacted you/your home/your community? 

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* 4. What actions have you taken to prepare your family/household for potential hazards?

  Have Done Plan to Do Not Done Unable to Do
Moved out of hazardous areas (floodplain, wildfire prone areas, or near major highways)
Braced or reinforced walls, foundations, chimneys, or utilities
Used fire-resistant building or roof materials
Maintain 30’ of bare space around homes or buildings
Signed up for emergency alerts from your county emergency management agency
Attended safety related training and certifications (CERT, First Aid, CPR, etc.)
Developed a Home Emergency Plan that describes what you will do during a natural disaster
Identified the safest place to be in your home/work during an earthquake
Developed an emergency plan for pets during disasters
Purchase safety related equipment (weather radios, go-packs, emergency supply kits)
Know how to shut off utilities
Know and are familiar with school and/or childcare's emergency procedures
Mapped evacuation routes

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* 5. If available, which of the following incentives would help to encourage you to retrofit your home to reduce the possible impacts of hazards.

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* 6. What are the best ways for you to receive information about hazards as they are occurring?

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* 7. What are the best ways for you to receive information about hazards and the threat they may pose to your household and property?

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* 8. Preparing for a disaster can take many forms. How important is it to mitigate potential hazard risk to the following?

  Very Important Somewhat Important Neutral Somewhat Not Important Not Important
Protecting people
Protecting private property
Protecting community assets (parks, community buildings)
Protecting critical facilities (hospitals, fire/police stations, utilities)
Preventing development in hazardous areas (example - flood prone areas)
Protecting natural environments
Protecting historical/cultural landmarks
Increasing cooperation between emergency response agencies and the public
Improving notification and weather alert communication systems 
Improving emergency response capabilities (fire/police/emergency management equipment and training)
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