Greetings,

If you or a member of your family live with a disability, we invite you to take this survey. The survey is a tool for the City of Portland’s Disability Program to get a better idea of how people with disabilities were affected by the recent snowstorm. The data we gather from the survey will be used to help advocate for emergency services specific to the needs of people with disabilities during inclement weather. The survey is just the beginning of a process to make changes. Your participation and personal advocacy will be needed to institute lasting solutions. You do not need to provide contact information to take the survey, but if you choose to provide contact information you will be contacted later in the process to lend your voice to the community advocacy effort.

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* 1. Do you experience limitations in one or more of the following tasks of daily living?
(check all that apply)

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* 2. Did you have any difficulty receiving information about the recent snowstorm?

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* 3. If yes, what would have helped you receive information?

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* 4. How did you receive ongoing information throughout the storm? (ex. TriMet closures)
Click all that apply

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* 5. Were you able to leave your house/apartment without assistance during the storm?

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* 6. If yes, what mode of transportation did you use?
(check all that apply)

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* 7. If you answered “No” to question 5, were you able to leave your house with assistance?

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* 8. If you needed to leave the house/apartment but could not, what was the reason?
(check all that apply)

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* 9. While at home, did you have difficultly with any of the following items?

  Y N
Getting care providers to or from your location
Getting food
Getting medicine
Getting to doctor/medical assistance
Caring for service animal/pet
Having access to hot water
Having access to heat
Understanding information about the storm
Locating information on closures and services

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* 10. If you answered yes to any of the above questions, use the space below to provide any additional information you think we should know.

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* 11. Have you ever taken an emergency self-preparedness class or training?

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* 12. Do you have an emergency support group?
(check all that apply)

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* 13. Government agencies sent out information through their websites and social media accounts throughout the storm. Did you check any of the following for storm-related information?

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* 14. If the Portland Disability Program/Additional Needs Registry set up a website or email alert process to relay information, would you sign up?

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* 15. Are there any additional comments you would like to make about your experience during the storm from 2/6/2014 – 2/11/2014?

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* 16. If you would like to be contacted in the future for disability-related emergency preparedness information or advocacy opportunities please provide:

Thank you for your participation in this survey. The data from this survey will be shared with government agencies as well as disability organizations including the Portland Commission on Disability, the Connecting Communities Coalition and the Disability Services Advisory Committee. If you need an ADA accommodation or alternative format to access the survey, have a questions about the survey or would like to see the survey data, contact Nickole Cheron: Nickole.Cheron@portlandoregon.gov or call (503) 823 9970.

For more information about emergency preparedness for people with disabilities, visit www.portlandoregon.gov/ONI/ANR.
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