Barber Valley & Mesa Neighborhood Community Preparedness Survey

The purpose of this survey is to better understand how prepared residents of the Mesa and Barber Valley Neighborhoods are to respond to a disaster, and to identify levels of interest in preparedness training.

Disaster Defined: “A sudden event, such as an accident or a natural catastrophe, that causes great damage or loss of life.” Examples of a disaster include wildfire, flooding, extreme weather, chemical spill, etc.

If you choose to provide your name and contact information, it will be used solely for the purpose of preparedness planning and training and will not be distributed or shared.
Sign in to Google to save your progress. Learn more
My household is prepared for a disaster in my neighborhood.
Clear selection
I am interested in participating in emergency preparedness training.
Clear selection
Do you have a preference for day/time? Do you have any needs, such as childcare or accommodations?
I understand what the process for evacuation looks like, how responders will communicate with me, and what supplies and materials I should have ready to go during a disaster.
Clear selection
What types of disasters do you worry about that could impact your neighborhood (from your subdivision boundary to your entire neighborhood association)? If you have multiple concerns, please rank them in order of greatest concern.
Additional Comments
Name (Optional)
Email (Optional)
Phone (Optional)
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy