Family Disaster Plan Checklist

Emergency Phone Numbers - (Program these into all phones and post them in a common area in the home.)

Address

Phone #

Police Department

Fire Department

Local Emergency Services

Local American Red Cross

Poison Help

1-800-222-1212

Healthcare Providers

· Doctor

· Dentist

· Other (add additional important personal contacts)

Employers and School Officials Contacts

· I know the emergency response plans for employers and schools. _____Yes _____No

Self, Spouse, Significant Other (names)

Employer/

School names

Address

Phone #

Facility Contact Name

Child’s Name

Child Day Care/Child School

Address

Phone #

Facility Contact Name

Family Communication Plan

Prepare a family communication plan so that each member of the family can contact one another quickly. (Put the 10 most important numbers on a card in your wallet.)

· Everyone has a cell phone or calling card ____ Yes _____ No

· Young children know how to call ( numbers are saved and they also have the 10 most important numbers on a card in their backpack.) ______ Yes _____ No

· These 10 important numbers may also include friends, church friends, school friends, co-workers, etc.

10 most important numbers

Name

Address

Phone

Email

1

2

3

4

5

6

7

8

9

10

You must include 10 important people.

One Location NEAR your home (neighbor/local friend):

Location

Address

Phone

Email

One Location AWAY from your home, in the event you cannot return home (school, recreation center, fire department, police station):

Location

Address

Phone

Email

Pick at least 1 or 2 friends or relatives who live out of the area, for household members to call/email to say they are okay. (If you want, add others as backup.)

Name

Address

Phone

Email

Emergency Floorplan

· NOTE: If you live in a multi-story dwelling, explain your escape route if you cannot use the stairs to exit the upper floors.

Everyone in the house knows how, when, and where to shut off utilities, prior to a disaster _ ___Yes _______ No

(This is done to mitigate damage to your residence)

Utility Company

(Include company name that services your residence)

Utility Company

(Include company phone number that services your residence)

Location of the Main Shut-Off or Main Controls at your residence

Electric Company Name

Water Company Name

Gas Company Name

Local Shelters-in case of evacuation

Address

Phone

Important Documents and Items Secured

Make sure you have copies of important documents and items that can be stored in a fireproof watertight container.

Important Items

Check off items that are safely stored/photocopied

Personal identification/Driver’s license

Cash/Credit Card(s)/Bank Information

Extra set of house keys and car keys

Birth certificate(s)

Marriage certificate

Passport/Visa/Social Security card

Wills/Deeds

Inventory of household goods (with photos & serial numbers)

Insurance papers

Medical information (for each family member)

Immunization records

Medications

Allergies

Stock/bonds

Emergency contact list (phone/address/email)

Local map and emergency shelter locations

Pet information

Additional:

Name of Veterinarian and Name of Local Animal Shelter:

Name of Veterinarian

Address

Phone

Email

Name of Local Animal Shelter

(Good to have if you find a lost pet.)

Address

Phone

Email

Names of pet friendly hotels/motels in and out of the area:

Name

Address

Phone

Email

Special needs assistance organization in your community.

Name

Address

Phone

Email

Consider ways to help neighbors who may need special assistance (ESL/medical/living alone).

Name

Special Help Needed

Address

Phone

Register with the local office of emergency services/preparedness or fire department.

Name

Address

Phone

Email

Stay current and up to date (e.g., BLS, Hospital Fire & Safety, etc.).

Certification

Date of Completion

Date of Renewal

Water

On Hand

Need to Acquire

Next water change (date)

Change water every 6 months.

One gallon of water per person, per day

One gallon/week supply of water stored for sanitary and cooking needs for household.

Additional Supply:

On Hand

Need to Acquire

Next water change (date)

Change water every 6 months.

Extra two quarts of water daily for children, nursing mothers, and those who are ill and need more.

High energy protein foods/fluids

On Hand

Need to Acquire

Nonperishable foods

Additional beverages

Additional Specialty Food Items:

On Hand

Need to Acquire

Add items you need for your family situation: (Put N/A if it not applicable to your needs.)

Infant foods

On Hand

Need to Acquire

Basic First Aid Supplies

On Hand

Need to Acquire

Check off all the basic items you have and list additional specialty items you have on hand:

First aid kit

Prescription medication list (ask your pharmacist about storing prescription medications)

Extra pair or prescription eyeglasses or contacts

Dust mask/masks

Nonprescription drugs

On Hand

Need to Acquire

Aspirin/non-aspirin pain relievers

Antidiarrheal/Laxative medications

Antacid

Vitamins

Additional First Aid Items

On Hand

Need to Acquire

Tools

On Hand

Need to Acquire

Check off all the basic items you have and list additional specialty items you have on hand:

Battery-powered or hand cranked radio

Cell phone/chargers/back up chargers

Flashlight

Extra batteries

Whistle

Matches in a waterproof container

Shut-off wrench, pliers, shovel, hammer, screwdriver, or multipurpose tool

Duct tape and scissors

Plastic sheeting

Whistle

A-B-C fire extinguisher

Compass

Work gloves

Paper, pen, pencils

Needles and thread

Additional Items:

On Hand

Need to Acquire

Sanitation and Hygiene

On Hand

Need to Acquire

Check off all the basic items you have and list additional specialty items you have on hand:

Towelettes, soap, hand sanitizer, other cleansers

Personal hygiene items

Heavy-duty plastic garbage bags

Medium sized plastic bucket with tight lid and small shovel for digging a latrine.

Additional Items:

On Hand

Need to Acquire

Kitchen

On Hand

Need to Acquire

Check off all the basic items you have and list additional specialty items you have on hand:

Manual can opener

Mess kits or paper cups, plates, plastic utensils

All-purpose knife

A dropper (eye dropper) with measurements

Liquid bleach to treat water.

Only use regular, unscented chlorine bleach products that are suitable for disinfection and sanitization as indicated on the label. The label may say that the active ingredient contains 6 or 8.25% of sodium hypochlorite. Do not use scented, color safe, or bleaches with added cleaners. If water is cloudy, let it settle and filter it through a clean cloth, paper towel, or coffee filter.

Aluminum foil, plastic wrap

Resealing plastic bags

Additional Items:

On Hand

Need to Acquire

If food must be cooked, a small camping stove and can of cooking fuel

Clothes and Bedding

On Hand

Need to Acquire

One complete change of clothes and footwear for each member of the household. Shoes should be sturdy work shoes or boots.

Rain gear, hats and gloves, extra socks and underwear, thermal underwear, sunglasses.

Blankets or sleeping bag and pillows for each member.

Additional Items:

On Hand

Need to Acquire

Items as needed for Baby

On Hand

Need to Acquire

List additional specialty items

Items as needed for Elderly

On Hand

Need to Acquire

List additional specialty items

Items as needed for Pets

On Hand

Need to Acquire

List additional specialty items

List items that you have added to personalize your emergency preparedness Go Bag.

Item

List items you need or would like to acquire to personalize your Go Bag.

Item

Plan in place

Yes/No

Conduct a family meeting to review the plan

Practice evacuation drills at least twice a year.

Update emergency contact information annually

Rotate and replace food, water, and batteries every 6 months

Ensure everyone knows the location of emergency kits and plans