Ready El Paso HOUSEHOLD Preparedness Questionnaire
This questionnaire is designed to help individual families determine a family’s household preparedness in emergency/disaster situations. The questionnaire should be completed by an adult, preferably the homeowner or head of household. The information you provide about your needs for disaster preparedness could help improve coordination efforts of preparedness and risk reduction activities within your community. Please take a few minutes to complete this questionnaire.

Natural Hazard Household Risk Reduction
Households can do many things to prepare for an emergency/disaster situation. What you have on hand or are trained to do when a disaster strikes can make a big difference in the hours and days following any emergency/disaster situation.
For example do you have enough water for up to 72 hours for each family member and pet? The questions below focus on your household preparedness for emergency/disaster situations.
How concerned are you about the following emergencies/disasters affecting your community?
Very Concerned
Somewhat Concerned
Not Concerned
Natural Disaster
Drought
Dust Storm
Flash Flood
Flood
Household Fire
Utility interruption
Earthquake
Windstorm
Severe Winter Storm
Are you concerned about future emergencies/disaster situations such as blackouts or winter storms that may affect your household?
Do you have an emergency preparedness plan for your family?
Would you want to be notified of neighborhood disaster preparedness plans?
In the following list, please check those activities that you have done in your household, plan to do in the near future, have not done, or are unable to do.
Have Done
Plan to Do
Not Done
Unable to Do
Attended meetings, or received written info on Natural disasters or emergency preparedness?
Talked with members in household about what to do in case of emergency/disaster situation?
Developed a Household/Family Emergency Plan in order to decide what everyone would do In the event of an emergency/disaster?
Prepared a “Disaster supply Kit” (stored food, water, batteries, or other emergency supplies)
In the last year, has anyone in your household Been trained in First Aid/CPR, CERT
Have you prepared your house for any type of Emergency situation….flash flooding, power outages
Secured your home to its foundation?
Elevated your home utilities for floods?
Part 2 - Community Risk Reduction
Natural disasters can impact a community; however, planning for these events can help lessen the impacts.
The following statements will help determine citizen priorities for planning for emergencies/disasters.
Important
Somewhat Important
Not Important
Protecting private property
Protecting critical facilities e.g.. hospitals, fire stations
Preventing development in hazard areas
Protecting historical and cultural landmarks
Protecting and reducing damage to utilities
Strengthening emergency services (e.g., police, fire ambulance)
Thank you very much for providing this information
Having a neighborhood that is self-sufficient is a comfort to all those involved. New friends are made, ideas are shared, problems are jointly solved, and a new sense of community pride will take place as plans are put into action.

If you are interested in further information please provide the following information below and check off the boxes for which you would like information.
Name: *
Your answer
Address:
Your answer
Zip Code: *
Your answer
Phone:
Your answer
Email: *
Your answer
If you are a member of a Neighborhood Association please identify your area by entering the name of your neighborhood association:
Your answer
If you are a member of a Neighborhood Watch Group please identify your area by Regional Command and Block Name:
Your answer
Do you currently belong to a Community Emergency Response Team (CERT)? If so, please enter your CERT District Area:
Your answer
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