Earthquake Preparedness Questionaraire

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Earthquake Task Force | Earthquake Preparedness Family Registry Form


TEMESCAL NEIGHBORHOOD EARTHQUAKE PREPAREDNESS QUESTIONNAIRE (1997)
Print this and mail it after it has been filled in.

(Please fill out each of the three forms, including the Family
Registry Form and the Special Skills/Equipment/Resources Form)


Name: ___________________________________

Phone: __________________________________

Address: ________________________________

e-mail (if available): _________________________


IF ENGLISH IS YOUR SECOND LANGUAGE, DO YOU NEED HELP TRANSLATING
THIS QUESTIONNAIRE AND OTHER EMERGENCY PREPARATION MATERIALS?

YES___

NATIVE LANGUAGE:_______________________



IS YOUR HOUSEHOLD PREPARED?


1. Is your house/apartment building bolted and sheerwalled?

YES___

NO___

NOT SURE___


2. Is your house/apartment building made of unreinforced masonry?

YES___

NO___

NOT SURE___


3. Is your waterheater strapped down (potential fire hazard)?

YES___

NO___

NOT SURE___


4. Are your heavy furniture items (such as book shelves) secured
(bolted to studs in the wall)?

YES___

NO___


5. Do you have at least a 3-day supply of water (plan on one gallon
per person, per day)

YES___

NO___


6. Do you have an emergency food supply?

YES___

NO___


7. Do you have a first aid kit?

YES___

NO___


8. Do you want help in evaluating/securing your home?

YES___

NO___




FOR APARTMENT DWELLERS (WITH MORE THAN 2 UNITS)


1. Are you willing to serve as a contact person for your apartment
building?

YES___

NO___


2. Name of Landlord:____________________________________


Landlord's Address:__________________________________


__________________________________


Landlord's Phone Number: ___________________________



DEVELOPING A NEIGHBORHOOD EMERGENCY PLAN


1. Are you willing to attend any planning meetings scheduled in the
future?

YES___

NO___

NOT ABLE TO NOW, BUT KEEP ME INFORMED___


2. Are you interested in joining any of the following earthquake
response teams? (check one--see attached pages describing team
responsibilities)


Damage Assessment___

Communications___

Sheltering and Special Needs___

Hazard Reduction___

Casualty Collection___

Search and Rescue___



3. Were you unable to attend the CORE training, but interested in
receiving copies of training materials?

YES___

NO___


4. Would you like to attend a CORE training in the future?

YES___

NO___

MAYBE___


5. Do you have space in a structurally sound garage or other unit
that you would be willing to make available as our neighborhood
command post, a place where we can store central supplies, and
gather after an earthquake and organize response teams?

YES___

NO___

MAYBE___


6. Are you willing/able to make a financial contribution ($5-25)
towards purchasing tools and supplies that would serve the entire
neighborhood in a disaster? (for example, ham radio, generator,
hard hats, radios, flashlights, bulletin boards, walkie talkies)

YES___

NO___

MAYBE LATER___


7. Are you willing to assist a neighbor in evaluating/securing
his/her home (for example, evaluate state of foundation, help bolt
book cases to the studs in walls, review safety measures, etc.)

YES___

NO___

MAYBE___


8. Are you willing to serve as a "disaster buddy" to a neighbor
with special needs (for example, someone with a physical
disability)?

YES___

NO___

MAYBE___


9. Would you like to be included in a phone tree to be notified
about special events?

YES___

NO___


10. Would you be willing to help make phone calls and/or distribute
notices about special events and planning meetings?

YES___

NO___



ORGANIZING BLOCK PARTIES


During times of distress it is easier to work with friends and
acquaintances than with strangers. Block parties--aside from being
a lot of fun (as those who attended the 44th Street block party
last September can testify)--can help to build friendly
associations that will make preparing for an earthquake a lot
easier. Please indicate whether you would like to work on any of
the following committees to plan another block party on 44th Street
(or on your block):

Publicity___

Food/Decorations___

Entertainment___

Kids Activities___

Check here if you have a special musical talent, and would be
willing to perform___




GENERAL CONCERNS


Any other concerns you'd like to express:
_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Copyright City of Oakland 1993


The neighborhood earthquake committees are still in the process of forming, so no one is officially "in charge" yet, but if you have questions or concerns about the questionnaire or about the emergency plan, please feel free to contact any of the following people who participated in the CORE trainings:

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)


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.