Family Emergency Plan
Make sure your family has a plan in case of an emergency. Before an emergency happens, sit down together and decide how you will
get in contact with each other, where you will go and what you will do in an emergency. Keep a copy of this plan in your emergency
supply kit or another safe place where you can access it in the event of a disaster.
Out-of-Town Contact Name:
Telephone Number:
Email:
Neighborhood Meeting Place:
Telephone Number:
Regional Meeting Place:
Telephone Number:
Evacuation Location:
Telephone Number:
Fill out the following information for each family member and keep it up to date.
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Social Security Number:
Important Medical Information:
Social Security Number:
Important Medical Information:
Social Security Number:
Important Medical Information:
Social Security Number:
Im
portant Medical Information:
Social Security Number:
Important Medical Information:
Social Security Number:
Important Medical Information:
Write down where your family spends the most time: work, school and other places you frequent. Schools, daycare providers, workplaces and
apartment buildings should all have site-specic emergency plans that you and your family need to know about.
Work Location One
Address:
Phone Number:
Evacuation Location:
Work Location Two
Address:
Phone Number:
Evacuation Location:
Work Location Three
Address:
Phone Number:
Evacuation Location:
Other place you frequent
Address:
Phone Number:
Evacuation Location:
School Location One
Address:
Phone Number:
Evacuation Location:
School Location Two
Address:
Phone Number:
Evacuation Location:
School Location Three
Address:
Phone Number:
Evacuation Location:
Other place you frequent
Address:
Phone Number:
Evacuation Location:
Important Information Name Telephone Number Policy Number
Doctor(s):
Other:
Pharmacist:
Medical Insurance:
Homeowners/Rental Insurance:
Veterinarian/Kennel (for pets):
Dial 911 for Emergencies
