Fillable 412 Family Emergency Plan And Template

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412 Family Emergency Plan And Template

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Emergency Operations Bureau
Sheriff’s Catastrophic Earthquake Team
EOB/SCET
This booklet is a plan template and is intended to give you a format and possible suggestions
about information you might want to include in a family disaster plan. It is not all-inclusive and
should be modified by the user to suit individual or family needs.
If filled in by hand, it is suggested that one use a pencil for ease of making future corrections to
information contained in the document.
Keep this plan updated with current and correct information.
Update and review plan: Last update: Next update:
Table
of
Contents
Household Earthquake Procedures During and Immediately After..…………………...4
1-24Hrs. After/Communication Plan/24Hrs.-3Days After………………..…..…………..5
Neighborhood Plan and Long Term Shelter In Place…..…………………………………6
Household Members and Pets Inventory…………………………………………………..7
Household Information………………………………………………………………..…….8
Emergency Numbers………………………………………………………………………...8
Utility and Service Contracts………………………………………………………………..9
Insurance and Other Information………………………………………………………..…9
Family/Friends/Neighbors and Out of Area Contact Information……………………….10
Work and School Contacts…………………………………………………………………..11
Reunion Information………………………………………………………………………...12
Important Notes and Procedures……………………………………………………………12
Medication List………………………………………………………………………………13
Pharmacy/Doctors/Specialists………………………………………………………………14
Home Layout and Design……………………………………………………………………15
Utility Control………………………………………………………………………………..16
Household Earthquake Procedures
During The Event
AT HOME:
Stay inside the house and find the nearest safe spot, usually away from glass or
objects that can fall on you. Find a solid table and "Drop, cover, and hold on to something."
IN BED:
Stay in bed and cover your head with a pillow and blankets.
OUTSIDE:
Stay outside and go to an area away from objects that can fall on you.
AT WORK:
Drop, cover, and hold on. DO NOT RUN.
IN A VEHICLE:
Safely slow down and come to a stop (if possible). Do not park on or under bridges, power lines,
or large trees.
Immediately After The Event
Check on family members/pets inside the house. Use shoes and a flashlight as glass may be
scattered throughout the house.
Conduct an inspection of the house. Walk the interior and perimeter. Evaluate if house appears to
be safe to re-enter. If it appears structurally unsound, stay outside. Remember there will be
aftershocks usually within an hour.
Check utilities (see chart on page 16).
o If you smell or hear gas, turn it off using attached wrench. If no sign of leakage, leave
it alone.
o If the electrical system is sparking or you smell electricity burning shut off the main
circuit breaker.
o If there are busted water lines, turn off the main valve. Wrench is located by gas line.
Open the water cover and turn the knob so it is horizontal.
Check and smell for fires. Fire extinguisher is located
4
Check on family members outside the house if phone lines are working. Remember hard lines and
texting will usually work best.
Contact your out of state family/friend(s) and advise them of your status.
Check on neighbor's welfare.
Make sure there are no gas leaks or fire around the immediate area. Help extinguish fires if possible
or turn off broken gas lines.
1-24 Hours After The Event
Prepare for numerous aftershocks.
Prepare for the long haul. If no power, water, or electricity consider running a generator.
Eat refrigerated items first as they will spoil, begin stock piling supplies and food.
Consider sleeping in a tent in the backyard if the house is not in stable condition.
Do not use candles for light as aftershocks can knock them down and create a fire or gas leaks
may create a fire.
Communication Plan
Communications will be necessary if the family is separated. If one type of communication system
is down you may need to fall back to another system:
Mobile phones
Hard phone lines
Email
Text messaging (typically the most reliable in or after a disaster)
Satellite phone
Amateur radio
24 Hours-3 Days
Begin talking to neighbors to pull resources together. Create a list of needs and haves.
Begin to ration food and water.
Sanitation: Use plastic bags in toilet if no running water.
5
Neighborhood Plan- Map My Neighborhood
Make sure your house and your family members are ok before anything else.
Tape a sign on your front door stating “Okay” or “Help.”
Gather at the predetermined meet spot.
Bring 2 fire extinguishers to the meet spot (gloves, lights, safety glasses).
Establish a team leader (IC) and scribe for below plan.
Make 4 strike teams for the following:
Team 1: Stay at the identified meet location and listen to radio for any news, information and/or
to gain situational awareness.
Team 2: Check on neighbors who are elderly, people with AFN, and children who maybe home
alone.
Team 3: Check on all neighbors’ houses for gas leaks. Shut off if necessary (Only shut off valve if
you smell or hear gas).
Team 4: Go to houses around the neighborhood and check on houses with “Help” signs on front door
or no card at all.
After the teams have finished their assignments, report back to the meet area to share what has been learned.
Long Term Shelter In Place (3 Or More Days)
Use a generator to plug appliances (refrigerator) into generator.
If available, use RV for shelter, water, propane, cooking, etc. Park on street.
Notify neighbors if you plan to evacuate and where you are evacuating to. Neighbor can look after
your property.
If your home is badly damaged, evacuate to relative or neighbor’s house.
Evacuate to local shelter (see phone # in contact list):
o Take as little as possible. Leave valuables in safe location. NO FIREARMS.
o Take medications, identification cards, etc.
o If taking pets, use pet carriers or leashes. Have dog tags on all pets and take photos
of pets for positive identification. Take food and water.
6
Household Members
Household Members Relation/Birth Date Social Security Number
Pets Pet License # Vet name & number
7
Household Information
Home Address:
Phone 1:
Phone 2:
E-mail 1:
E-mail 2:
Car Information
Car 1: Make/
Model/
Year/
License #
Car 2: Make/
Model/
Year/
License #
Car 3: Make/
Model/
Year/
License #
Emergency Numbers
CALL 911 FOR EMERGENCY
Doctor # 1
Doctor # 2
Doctor # 3
Fire Number
Police Number
Ambulance Number
Poison Control Number
Hospital Emergency Room
American Red Cross
Evacuation Center
Name/Number
Name/Number
Name/Number
Name/Number
Note: After a disaster, 911 may not be working. You may also call LA County Info, 211 or
(800) 339-6993.
8
Utility and Service Contacts
Insurance/Other Information
9
Organization Name
Water/Sewer
Address
Contact
Note
Phone
Organization Name
Electric
Address
Contact
Note
Phone
Organization Name
Gas
Address
Contact
Note
Phone
Organization Name
Phone/cable
Address
Contact
Note
Phone
Organization Name
Home Medical
Address
Contact
Note
Phone
Name
Policy#/Other Information
Phone
Family/Friends/Neighbors
Note: Identify two neighbors. Agree to check on each other.
Out-of-Area Contact #1
Important: During disasters, use phone for emergencies only. Local phone lines may be tied up.
Make one call out-of-area to report in. Let this person contact others.
Out-of-Area Contact #2
10
Name
Address/Physical Location
To Home
Hm./Wk. Phone
E-mail Address
Cell phone Number
Name
Home Address
Home Phone
E-mail Address
Work Address
Work Phone
Cell Phone Number
Name
Home Address
Home Phone
E-mail Address
Work Address
Work Phone
Cell Phone Number
Work, School, and Other Contacts
Note: *Disaster Procedures: Household members should know each other’s disaster procedures
for work, school, or other places where they spend time during the week.
11
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Household Member Name
Work/School/Other
Disaster Procedures*
Address
Phone
Reunion Procedures
Note: Identify and discuss with household members the reunion places if a disaster prevents
anyone from entering the home. Also, reunion and evacuation procedures need to include
children at school and house members with disabilities. Talk to school officials. Write down
procedures.
Important Notes and Procedures
Note: People with disabilities are advised to identify two or three people at work, school,
neighborhood, etc. who will assist them in the event of a disaster.
12
In or Around House/Apartment
Inside House/Apartment
Outside House/Apartment
When Family is Not Home
Priority Location
(Leave note in a designated place where you will be: i.e.,
neighbor, relative, park, school, shelter, etc.)
Medication List
Note: Keep on hand at least seven days of vital medications and supplies. Talk to doctor before
storing medication or if you use two or more medications.
Last update of this page:
13
User’s Name
Medication Name
Dosage/Frequency
Reason for Taking
Doctor
Prescription #
Date Started/Ending
Location of Medicine
User’s Name
Medication Name
Dosage/Frequency
Reason for Taking
Doctor
Prescription #
Date Started/Ending
Location of Medicine
User’s Name
Medication Name
Dosage/Frequency
Reason for Taking
Doctor
Prescription #
Date Started/Ending
Location of Medicine
User’s Name
Medication Name
Dosage/Frequency
Reason for Taking
Doctor
Prescription #
Date Started/Ending
Location of Medicine
Pharmacy/Doctors/Specialists
Note: Fill this and all sections out in pencil. Update regularly. If additional information is
needed, tape or staple another sheet of paper.
Last Update of the Page:
14
Pharmacist
Name(s)
Pharmacy Name
Phone/Address
Pharmacy Name
Phone/Address
Specialist Name
Area of Concern
Phone
Organization
Address
Specialist Name
Area of Concern
Phone
Organization
Address
Allergies to
Medications
Person’s Name
Person’s Name
Medication
Medication
Health/Disability
Information
Special Needs,
Equipment, and
Supplies
Home Layout/Diagram
Draw a layout of your home. Make sure you include locations of utility shutoffs and safety
equipment like fire extinguishers, disaster supplies, etc.
15
Utility
Control
Locate
each
of
these
utility
control
points
in
your
home.
Electrical
Shut-Offs
Step
2
Step
1
Gas
Meter
And
Shut-Off
Valve
Gas
Meter
And
Water
Shut-Off
Label
for
quick
identification
Circuit
Breaker
Pull-out
Cartridge
Fuses
Shut-Off
Valve
Have
wrench
stored
in
a
specific
location
where
it
will
be
immediately
available
Electricity:
In
the
event
that
you
need
to
turn
off
the
electricity
in
your
house,
go
to
the
breaker
box
and
do
the
following:
1.
Turn
off
smaller
breakers
one
by
one
2.
Flip
the
“main”
breaker
last
To
reenergize
your
home,
reverse
the
steps
above.
Water:
In
the
event
you
need
to
shut
water
off
inside
your
home,
find
the
main
water
valve
and
turn
it
to
your
right.
To
open
the
flow
of
water
back
into
the
house,
turn
it
to
your
left.
Gas:
IMPORTANT
–
Only
turn
off
the
gas
at
the
meter
if
you
smell
gas!
To
turn
off
natural
gas
in
your
house,
take
a
wrench
and
tighten
it
on
to
the
quarter
turn
valve
that
is
on
the
pipe
that
feeds
into
the
gas
meter.
Turn
it
one-quarter
turn
to
make
the
indicator
parallel
to
the
ground.
In
most
locations,
once
you
do
this
you
cannot
turn
the
gas
back
on
to
the
house
without
the
utility
company.
Propane:
If
you
live
in
an
area
that
uses
outdoor
propane
or
LPG
you
will
find
this
outside
the
home.
Open
the
top
of
the
tank
and
you
will
see
either
a
regular
turn
knob
or
a
quarter
turn
valve.
Turn
the
knob
to
your
right
to
shut
off
the
flow
of
propane
into
your
house.
For
quarter
turn
valve
see
above.
16
Recommended
Items
to
Include
in a
Basic
Emergency
Supply
Kit:
Water, one gallon of water per person per day for at least three days,
for drinking and sanitation
Food, at least a three-day supply of non-perishable food
Battery-powered or hand crank radio and a NOAA Weather Radio
with tone alert and extra batteries for both
Flashlight and extra batteries
First aid kit
Whistle to signal for help
Dust mask, to help filter contaminated air and plastic sheeting
and duct tape to shelter-in-place
Moist towelettes, garbage bags and plastic ties for personal sanitation
Wrench or pliers to turn off utilities
Can opener for food (if kit contains canned food)
Local maps
Additional
Items
to
Consider
Adding
to
an
Emergency
Supply
Kit:
Prescription medications and glasses
Infant formula and diapers
Pet food and extra water for your pet
Important family documents such as copies of insurance policies, identification
and bank account records in a waterproof, portable container
Cash or traveler’s checks and change
Emergency reference material such as a first aid book or information
from www.ready.gov
Sleeping bag or warm blanket for each person. Consider additional
bedding if you live in a cold-weather climate.
Complete change of clothing including a long sleeved shirt, long
pants and sturdy shoes. Consider additional clothing if you live in a
cold-weather climate.
Household chlorine bleach and medicine dropper – When diluted nine parts water
to one part bleach, bleach can be used as a disinfectant or in an emergency, you
can use it to treat water by using 16 drops of regular household liquid bleach per
gallon of water. Do not use scented, color safe, or bleaches with added cleaners.
Fire Extinguisher
Matches in a waterproof container
Feminine supplies and personal hygiene items
Mess kits, paper cups, plates and plastic utensils, paper towels
Paper and pencil
Books, games, puzzles or other activities for children
Prepare For Emergencies Now:
Information For Pet Owners
1. Get a Kit of pet emergency supplies.
Just
as
you
do
with
your
family’s
emergency
supply
kit,
think
first
about
the
basics
for
survival,
particularly
food
and water.
Food: Keep at least three days of food in an airtight, waterproof container.
Water: Store at least three days of water specifically for your pets, in addition to water you
need for yourself and your family.
Medicines and medical records: Keep an extra supply of medicines your pet takes on a
regular basis in a waterproof container.
First aid kit: Talk to your veterinarian about what is most appropriate for your pet’s
emergency medical needs. Most kits should include cotton bandage rolls, bandage tape
and scissors; antibiotic ointment; flea and tick prevention; latex gloves, isopropyl alcohol
and saline solution. Include a pet first aid reference book.
Collar with ID tag, harness or leash: Your pet should wear a collar with its rabies tag
and identification at all times. Include a backup leash, collar and ID tag in your pet’s
emergency supply kit.
Important documents: Place copies of your pet’s registration information, adoption
papers, vaccination documents and medical records in a clean plastic bag or waterproof
container and also add them to your kit.
Crate or other pet carrier: If you need to evacuate in an emergency situation take your pets
and animals with you, provided that it is practical to do so.
Sanitation: Include pet litter and litter box if appropriate, newspapers, paper towels, plastic
trash bags and household chlorine bleach to provide for your pet’s sanitation needs. You can
use bleach as a disinfectant (dilute nine parts water to one part bleach), or in an emergency
you can also use it to purify water. Use 8 drops of regular household liquid bleach per gallon
of water, stir well and let it stand for 30 minutes before use. Do not use scented or color safe
bleaches or those with added cleaners.
A picture of you and your pet together: If you become separated from your pet during an
emergency, a picture of you and your pet together will help you document ownership and
allow others to assist you in identifying your pet. Include detailed information about species,
breed, age, sex, color and distinguishing characteristics.
Familiar items: Put favorite toys, treats or bedding in your kit. Familiar items can help reduce
stress for your pet.
Consider
two
kits.
In
one,
put
everything
your
pets
will
need
to
stay
where
you
are
and
make
it
on
your
own.
The
other
should
be
a
lightweight,
smaller
version
you
can
take
with
you
if
you
and
your
pets
have
to
get
away.
2.
Make
a
Plan
for
what
you
will
do
in
an
emergency.
Plan
in
advance
what
you
will
do
in
an
emergency.
Be
prepared
to
assess
the
situation.
Use
common
sense
and
whatever you have on hand to take care of yourself and ensure your pet’s safety during an emergency.
For more information, visit ready.gov or call 1-800-BE-READY
Prepare For Emergencies Now:
Information For Pet Owners
Evacuate.
Plan
how
you
will
assemble
your
pets
and
anticipate
where
you
will
go.
If
you
must
evacuate,
take
your
pets
with
you,
if
practical.
If
you
go
to
a
public
shelter,
keep
in
mind
your
pets
may
not
be
allowed
inside.
Secure
appropriate
lodging
in
advance
depending
on
the
number
and
type
of
animals
in
your
care.
Consider
family
or
friends
outside
your
immediate
area
who
would
be
willing
to
take
in
you
and
your
pets
in
an
emergency.
Other
options
may
include:
a
hotel
or
motel
that
takes
pets
or
some
sort
of
boarding
facility,
such
as
a
kennel
or
veterinary
hospital
that
is
near
an
evacuation
facility
or
your
family’s
meeting
place.
Find
out
before
an
emergency
happens if any of these facilities in your area might be viable options for you and your pets.
Develop
a
buddy
system.
Plan
with
neighbors,
friends
or
relatives
to
make
sure
that
someone
is
available
to
care
for
or
evacuate
your
pets
if
you
are
unable
to
do
so.
Talk
with
your
pet
care
buddy
about
your
evacuation
plans
and
show
them
where
you
keep
your
pet’s
emergency
supply
kit.
Also
designate
specific
locations,
one
in
your immediate neighborhood and other farther away, where you will meet in an emergency.
Talk
to
your
pet’s
veterinarian
about
emergency
planning.
Discuss
the
types
of
things
you
should
include
in
your
pet’s
emergency
first
aid
kit.
Get
the
names
of
vets
or
veterinary
hospitals
in
other
cities
where
you
might
need
to
seek
temporary
shelter.
Also
talk
with
your
veterinarian
about
microchipping.
If
you
and
your
pet
are
separated,
this
permanent
implant
for
your
pet
and
corresponding
enrollment
in
a
recovery
database
can
help
a
veterinarian
or
shelter
identify
your
animal.
If
your
pet
is
microchipped,
keeping
your
emergency
contact
informa-
tion
up
to
date
and
listed
with
a
reliable
recovery
database
is
essential
to
you
and
your
pet
being
reunited.
Gather
contact
information
for
emergency
animal
treatment.
Make
a
list
of
contact
information
and
ad-
dresses
of
area
animal
control
agencies
including
the
Humane
Society
or
ASPCA
and
emergency
veterinary
hospitals.
Keep
one
copy
of
these
phone
numbers
with
you,
and
one
in
your
pet’s
emergency
supply
kit.
Obtain
“Pets
Inside”
stickers
and
place
them
on
your
doors
or
windows,
including
information
on
the
number
and
types
of
pets
in
your
home
to
alert
firefighters
and
rescue
workers.
Consider
putting
a
phone
number
on
the
sticker
where
you
could
be
reached
in
an
emergency.
And,
if
time
permits,
remember
to
write
the
words
“Evacuated
with Pets” across the stickers, should you evacuate your home with your pets.
3. Be Prepared for what might happen.
Some
of
the
things
you
can
do
to
prepare
for
the
unexpected,
such
as
assembling
an
emergency
supply
kit
for
yourself,
your
family
and
your
pets,
is
the
same
regardless
of
the
type
of
emergency.
However,
it’s
important
to
say
informed
about
what
might
happen
and
know
what
types
of
emergencies
are
likely
to
affect
your
region.
Be
prepared
to
adapt
this
information
to
your
personal
circumstances
and
make
every
effort
to
follow
instruc-
tions
received
from
authorities
on
the
scene.
With
these
simple
preparations,
you
can
be
ready
for
the
unex-
pected.
Those
who
take
the
time
to
prepare
themselves
and
their
pets
will
likely
encounter
less
difficulty,
stress
and worry. Take the time now to get yourself and your pet ready.
Developed in partnership with:
For more information, visit ready.gov or call 1-800-BE-READY
GENERAL EMERGENCY SITUATION INFORMATION
Warning:
Alert LA County
Register
your
cell
phone
number,
Voice
over
IP
phone
number,
and
e-mail
address
with
the
Alert
LA
County
Emergency
Mass
Notification
System
(
http://alert.lacounty.gov
)
Listed
and
unlisted
land
line
telephone
numbers
are
already
included
in
the
database and
do
not
need
to
be
registered.
Los Angeles County has implemented an emergency mass notification system that will be used to contact County
residents and businesses via recorded phone messages, text messages or e-mail messages in case
of emergency. The system, called
Alert
LA
County
, will be used by the County’s Emergency Operations Center
to notify residents and businesses of emergencies or critical situations and provide information regarding
necessary actions, such as evacuations. The system utilizes the telephone companies’ 911 database and is
able to contact land-line telephone numbers, whether listed or unlisted. If the call is picked up by an answering
machine, the system will leave a recorded message. If the number called is busy or does not answer, the
system will redial the number in an attempt to deliver the message. The system is also TTY/TDD compatible.
Because the
Alert
LA
County
system uses the 911 database, only land-line numbers are automatically included in the
system. If you have a cellular or Voice over IP number and would like to be notified on that device, or if you would
like an e-mail notification, you must register those telephone numbers and/or e-mail address by completing the
registration form below.
Because the
Alert
LA
County
system uses geo-mapping, each telephone number and/or e-mail address can only be
associated with one street address in the system.
In Los Angeles County, general public warning information can come from the following sources:
o Local broadcast media (although not inclusive – TV - Channels 2, 4, and 7; AM Radio – 980 and 1070)
o NOAA All Hazard Weather Radio
Identify
what
information you will need to make clear and appropriate decisions.
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