Earthquake Preparedness

Earthquake Preparedness Forms

Please print and forward:

EARTHQUAKE PREPAREDNESS FAMILY REGISTRY FORM

Family/household name:_____________________________________________

Address:___________________________________________________________

Phone (day/evening):_______________________________________________

E-mail address:____________________________________________________

Out-of-area contact person:________________________________________

Phone: ( )_______________________________________________________

ADULTS IN HOUSEHOLD

1. Name____________________________________________________________

Work hours:_____________________________________________________

Work address:___________________________________________________

Phone:__________________________________________________________

E-mail address:_________________________________________________

2. Name____________________________________________________________

Work hours:_____________________________________________________

Work address:___________________________________________________

Phone:__________________________________________________________

E-mail address:_________________________________________________

CHILDREN

Names

Age/Grade

School

_________________________

_________________________

_________________________

_________________________

_________________________

_________________________

MEMBERS OF HOUSEHOLD WHO MAY NEED SPECIAL ASSISTANCE IN AN

EMERGENCY SITUATION

Name

Special Need/Type of Assistance Needed

_________________________

________________________________________

_________________________

________________________________________

_________________________

________________________________________

_________________________

________________________________________

PETS

Name

Breed/Type

Description

In/Outdoors

_________________

_________________

________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

Copyright City of Oakland 1993


EARTHQUAKE PREPAREDNESS SPECIAL SKILLS/EQUIPMENT/RESOURCES FORM

Household:_________________________________________________________

Address:___________________________________________________________

Special Skill/Training

Name (Carpentry, electrical, plumbing,

fire fighting, medical, etc.)

________________________________ _________________________________

________________________________ _________________________________

________________________________ _________________________________

________________________________ _________________________________

________________________________ _________________________________

We might be able to provide temporary housing for _____ displaced

neighbors.

We have a potential source of water for fire fighting (pool, hot

tub, cistern, etc.):

Yes_____

No______

Please complete this form and return in to your Division Supervisor

Copyright City of Oakland 1993


Also, please fill out the Earthquake Preparedness Questionaire (1997)

There is also more information here on Earthquake Task Force Rolls and Responsibilities.


Forward printed forms to:

44th Street * Sally Thomas, 471-44th (658-9673)
Laura Jackson (601-1580)
Howard Lasseter (601-6729)
Gloria Cobb (428-0827)

45th Street * Tom Wenzel, 416-45th (601-0574)
Patrick Hickey (428-7633)

Webster Street * Cathy Steirn, 4415 Webster (547-3193)
John Goodwin (655-6727)


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If you have information for any of the above, suggestions, questions or simply words of encouragement, please contact Andy Miller. Also, check my shadowdog.com site.