OMVNA CERT Participation Survey
Greetings OMVNA CERT members,

To better plan our neighborhood CERT response to an emergency, the OMVNA CERT Steering Committee requests information from you, our CERT Member, about your intention to actively serve (or not) in the event of a disaster and what level of participation is likely based on capabilities and training. We understand that circumstances do change and this is for information only and not considered a firm commitment.

In this first section,  Please review the following pre-emergency preparations and respond with
your status or intentions as appropriate.
Sign in to Google to save your progress. Learn more
I have a minimum of 3 days (more is better) of food, water and supplies for my household to be used in an emergency. *
My FRS/GMRS radio is accessible and kept charged for use. *
I intend to participate in the OMVNA CERT radio check-in on the first Sunday of every month (channel 21, 5-10 min) *
CERT events offered by the Mountain View Fire Department
The Mountain View Fire Department holds CERT refreshers, courses, and drills.  We encourage you to attend and keep your skills fresh!
You can learn more about, and register for upcoming refreshers or courses at 
The 2020 refreshers are
Th. Feb. 6, 7-9 PM:  CERT Tools for Leadership
Sat. April 18, 9 AM-12 PM: Terrorism Awareness,
Th. Aug. 27, 7-9 PM: Medical Treatment
Wed. Nov. 4, 7-9 PM Action Planning

The City-wide drills are
Sat. May 9, 1-5 PM
Sat. Nov. 14, 1-5 PM

If you have not taken the 19-hour course or feel like it's been too long since you attended (suggested: 5 years) then please consider taking one of the courses offered in April, May, or October.
I plan to attend one or more CERT Refreshers *
I plan to attend one or both City-wide drills *
Roles, interests, and capabilities
 In this section, please indicate your level of interest in participating in the listed roles.  We'll ask about your specific skills and qualifications afterwards.  Of course, this is non-binding, and volunteers may be asked to help where they can help the most.
"Field Team" - In the event of a disaster or emergency, I intend to serve on a CERT Field Team. *
Not at all
Neighborhood Assessment
Medical Response (comment below)
Fire Suppression (as safety allows)
Light Search and Rescue
"Command Post" -- In the event of a disaster or emergency, I am interested in participating with Command Post activities. *
Not at all
Logistics - manage resources, services and supplies.
Planning - data collection and display.
Medical Treatment and Management
Communications (HAM radio)
Medical participants: please briefly describe your level of training or expertise, particularly if you have professional training or attended a CERT course
Communications: Please provide any FCC licenses you have (HAM and/or GMRS call sign). Also, please list any specialized radio equipment and skills (such as packet operations)
Do you want the CERT leaders to know of any other skills or equipment you feel may help your neighbors in an emergency situation?  (skills like ASL or translation? equipment like a pop up shelter or an over abundance of first aid supplies?)
Alternatively, if you wish to withdraw from OMVNA CERT, the Steering Committee asks you to please make an arrangement to return the CERT FRS(GMRS) radio that was assigned to you at your earliest convenience.  
Your Name (and email address if we don't have it) *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy