Fill - Free fillable ARC Family Disaster Plan Template R083012 PDF form

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FamilyDisasterPlan

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FamilyLastNa

me(s)orHouseholdAddress:Date:

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FamilyMember/HouseholdContactInfo (If needed, additional space is provided in #10 below):

Name

HomePhone CellPhone Email:

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Pet(s)Info:

Name:

Type:  Color:  Registration#:

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PlanofAction

1.Thedisastersmostlikelytoaffectourhouseholdare:

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2.Whataretheescaperoutesfromourhome?

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3.Ifseparatedduringanemergency,whatisourmeetingplacenearourhome?

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4.Ifwecannotreturnhomeorareaskedtoevacuate,whatisour meetingplaceoutsideofour

neighborhood?

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Whatisourroutetogetthereandanalternateroute,ifthefirstrouteisimpassible?

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5.Intheeventourhouseholdisseparatedorunabletocommunicatewitheachother,our

emergency

contactoutsideofourimmediateareais:

Name

HomePhone CellPhone Email:

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Afteradisaster,letyourfriendsandfamilyknowyouareokaybyregisteringat“SafeandWell”at

https://safeandwell.communityos.org/cms//

orbycalling1‐800‐733‐2767.Youcanalsogivethema

call,sendaquicktextorupdateyourstatusonsocialnetworkingsites.

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6.Ifatschool/daycare,ourchild(ren)willbeevacuatedto:

Child’sName

  EvacuationSite(addressandcontactinfo):

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7.Ourplanforpeopleinourhouseholdwithadisabilityorspecialneedis:

Person’sName:

  Plan:

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8.Duringcertainemergencieslocalauthoritiesmaydirectusto“shelterinplace”inourhome.An

accessible,saferoomwherewecango,sealwindows,ventsanddoorsandlistentoemergency

broadcastsforinstructions,is:

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9.FamilyMemberResponsibilitiesintheEventofaDisaster

Task Description

Family

Member

Responsible

DisasterKit* Stockthedisasterkit andtakeitifevacuationisnecessary.Include

itemsyoumightwanttotaketoaneva cuationshelter.Remember

toincludemedicationsandeyeglasses.

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Beinformed MaintainaccesstoNOAAorlocalradio,TV,emailortextalertsfor

importantandcurrentinformationaboutdisasters.

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Family

Medical

Information

Makesurethehouseholdmedicalinformationistakenwithusif

evacuationisnecessary.

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Financial

Information

ObtaincopiesofbankstatementsandcashintheeventATMsand

creditcardsdonotworkduetopoweroutages.Bringcopiesof

utilitybillsasproofofresidenceinapplyingforassistance.

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Pet

Information

Evacuateourpet(s),keepaphonelistofpet‐friendlymotelsand

animalshelters,andassembleandtakethepetdisasterkit.

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Sharingand

Maintaining

thePlan

Sharethecompletedplanwiththosewhoneedtoknow.Meet

withhouseholdmembersevery6monthsorasneedschangeto

updatehouseholdplan.

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*Whatsuppliesandrecordsshouldgoinyourdisasterkit?Visitwww.redcross.org

10.Otherinformation,ifnotabletobeincludedabove.

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Congratulationsoncompletingyourfamilydisasterplan!Pleasetellothers:“We’vemadeafamilydisasterplan

andyoucan,too,withhelpfromtheAmericanRedCross.”

Getthefactsaboutwhatyoushoulddoifanemergencyordisasteroccursatwww.redcross.org

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ARC Family Disaster Plan Template R083012

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