* 1. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

* 2. Are you aware that a major earthquake is likely in your community?

* 3. Which type of natural disaster is most likely to occur in your community? (check all that apply)

* 4. How confident are you in your ability to know what to do in the first five minutes of a sudden natural disaster such as an earthquake that occurs without warning?
Please use a scale of 1 to 5, with 5 being "very confident" and 1 being "not at all confident".

i We adjusted the number you entered based on the slider’s scale.

* 5. In thinking about preparing yourself for a major disaster, which best represents your preparedness?

* 6. If you have not taken any preparedness actions, what is the primary reason?

* 7. In the past 6 months, have you done any of the following?

* 8. Do you have supplies set aside in your home to be used only in case of a disaster?

* 9. Have you taken any of the following steps to protect your home, it's structure and furnishings?

* 10. If you have not, what is keeping you from making improvements to your dwelling?

* 11. Does your household have supplies and an emergency plan that includes instructions for household members about where to go and what to do in the event of a disaster?

* 12. Are you familiar with the alert and warning systems in your community?  (How you will be notified of an emergency in your area)

* 13. In the past 6 months, there have been drills, education, and advertising activities to raise awareness of the risk of earthquakes in Oregon and to help people prepare for the possibility of an earthquake in Oregon.  Have you read, seen, or heard anything about that?

* 14. If you answered "yes" to the above, how did you hear about it?

* 15. Is the phrase, "Drop! Cover! Hold on!" familiar to you?

* 16. In the past 12 months, have you participated in any of the following?

* 17. Do you believe your community is adequately prepared for a major disaster?

* 18. Why do you believe, or not, that the community is adequately prepared?

* 19. Do you believe that community preparedness can make a difference in the ability of emergency officials to respond after a disaster?

* 20. Are you aware of the local emergency plans in your community?

* 21. What steps do you believe local officials can take to better prepare your community for the impacts of an earthquake and tsunami?

* 22. What role do citizens have in preparing for and responding to a major earthquake in your community?