_________________________________________________________________________
Name: Date: Revise Date:
(This is generally done annually
unless you have life changes.)
One of the most important steps you can take in preparing for emergencies is to develop a household disaster plan. This involves creating a plan that identifies who you can contact in an emergency, what each member of your family must do, and how you can better prepare yourself for the situation. (Veenema, 2009)
Research potential disasters that could occur in your community. Select 2 (two) potential disasters and using about 25 words, examine how these potential disasters can impact you as a nurse. Provide at least 1 reference for each potential disaster. Use APA Style for your reference(s) and include in-text citation(s). Write your word count at the end of your paragraph for each possible hazard. Get Feminist Criminology Homework Help!!
Reference
Reference
Emergency Phone Numbers – (Program these into all phones and post in a common area in the home.) | ||
Address | Phone # | |
Police Department | ||
Fire Department | ||
Local Emergency Services | ||
Local American Red Cross | ||
Poison Help | 1-800-222-1212 | |
Healthcare Providers | ||
· Doctor | ||
· Dentist | ||
· Other (add additional important personal contacts) |
Employers and School Officials Contacts
I know the emergency response plans for employers and schools. _____
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Self, Spouse, Significant Other (names) | Employer/School | Address | Phone # | Facility Contact Name |
Child’s Name | Child Day Care/Child School | Address | Phone # | Facility Contact Name |
Family Communication Plan
Prepare a family communication plan so that each member of the family can contact one another quickly. (Put 10 most important numbers on a card in your wallet.) · Everyone has a cell phone or calling card _____ · Young children know how to call (numbers are saved and they also have the 10 most important numbers on a card in their backpack.) ______
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10 most important numbers | Name | Address | Phone | |
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 |
Identify two meeting places for your family, in the event you are separated.
One Location NEAR your home (neighbor/local friend): | |||
Location | Address | Phone | |
One Location AWAY from your home, in the event you cannot return home (school, recreation center, fire department, police station): | |||
Location | Address | Phone | |
Pick at least 1 or 2 friends or relatives who live out of the area, for household members to call/email to say they are okay. (If you want, add others as backup.) | |||
Name | Address | Phone | |
(See example below: Bastrop County Office of Emergency Management).
If you still have questions on how to submit this assignment, please ask before submitting.
Emergency Floorplan | |||
Everyone in the house knows how, when, and where to shut off utilities, prior to a disaster. This is done to mitigate damage to your residence. ______
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Utility Company Name | Utility Company
Phone Number |
Location of the Main Shut-Off or Main Controls at your residence | |
Electric Company Name
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Water Company Name
|
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Gas Company Name
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List a neighbor/family member or 2 and a local government agency.
(Example: Area Rapid Transit) |
Address | Phone |
Important Documents and Items Secured
Make sure you have copies of important documents and items that can be stored in a fireproof watertight container. |
|
Important Items | Check off items that are safely stored/photocopied |
Personal identification | |
Cash and coins | |
Credit card(s) | |
Extra set of house keys and car keys | |
Birth certificate | |
Marriage certificate | |
Driver’s license | |
Social Security card | |
Passport/visa | |
Wills | |
Deeds | |
Inventory of household goods (with photos & serial numbers) | |
Insurance papers | |
Immunization records
— Allergies — Medications |
|
Bank and credit card numbers | |
Stock/bonds | |
Emergency contact list (phone/address/email) | |
Local map and emergency shelter locations | |
Pet information | |
Additional: | |
As per local and state health and safety regulations, pets may not be permitted in some shelters such as American Red Cross shelters. Service animals are permitted.
Name of Veterinarian and Name of Local Animal Shelter: | |||
Name of Veterinarian | Address | Phone | |
Name of Local Animal Shelter
(Good to have if you find a lost pet.) |
Address | Phone | |
Names of pet friendly hotels/motels in and out of the area: | |||
Name | Address | Phone | |
Create a network of neighbors, friends, relatives, coworkers to aid you in an emergency.
Special needs assistance organization in your community. | |||
Name | Address | Phone | |
Register with the local office of emergency services/preparedness or fire department. | |||
Name | Address | Phone | |
Consider ways to help neighbors who may need special assistance (ESL/medical/living alone). | |||
Name | Special Help Needed | Address | Phone |
Stay current and up to date (e.g., CPR, ACLS, PALS, TNCC). | ||
Certification | Date of Completion | Date of Renewal |
You and your family may need to survive on your own for 3 days or more. Consider having additional supplies for up to two weeks confinement or shelter. You should prepare emergency supplies for the following situations:
Make sure all family members know where the go bags are and have access to them.
Home go-bag _____
Pet go-bag _____
Child go-bag with special items for feeling safe and staying occupied _____
Vehicle go-bag – 3-day supplies included with emergency roadside equipment _____
Work go bag _____
Stocking water supplies should be a top priority. Drinking water in emergency situations should not be rationed. It is critical to store adequate amounts of water for your household.
Water
|
On Hand | Need to Acquire | Next water change (date)
Change water every 6 months. |
Two quarts of water daily for drinking for each person in household | |||
One gallon/week supply of water stored for sanitary and cooking needs for household. | |||
Additional Specialty Items: | On Hand | Need to Acquire | Next water change (date)
Change water every 6 months. |
Extra two quarts of water daily for children, nursing mothers, and those who are ill and need more. |
Food, unlike water may be rationed except for children and pregnant women. No special food needed. Keep canned foods and dry mixes stocked. Replenish food supplies every 6 months. Use and replace. Store newer items in the back, older items in front.
High energy protein foods | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
Peanut butter | ||
Trail mix | ||
Granola bars | ||
Peanuts | ||
Hard candy | ||
Boxed juices | ||
Powdered milk | ||
Dry fruits | ||
Additional Specialty Items: | On Hand | Need to Acquire |
Add items you need for your family situation: (Put N/A if it not applicable to your needs.) | ||
Infant foods | On Hand | Need to Acquire |
Specialty diet foods | On Hand | Need to Acquire |
Assemble a first aid kit for your home. ____ Assemble a first aid kit for each vehicle. _____
Basic First Aid Supplies | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: Family Disaster Plan Checklist | ||
First aid manual | ||
Sterile adhesive bandages, assorted sizes | ||
Safety pins assorted sizes | ||
Cleansing agents | ||
Antibiotic ointment | ||
Latex gloves (2 pair) | ||
Petroleum jelly or other lubricant | ||
2-inch and 4-inch sterile gauze pads (4 to 6 of each) | ||
Triangular bandages (3) Family Disaster Plan Checklist | ||
Sunscreen | ||
Scissors | ||
2-inch and 3-inch sterile roller bandages (3 rolls each) | ||
Tweezers | ||
Needle | ||
Moistened towelettes | ||
Antiseptic | ||
Thermometer | ||
Tongue depressor blades (2) | ||
Prescription medication list (ask your pharmacist about storing prescription medications) | ||
Extra pair or prescription eyeglasses or contacts
Family Disaster Plan Checklist |
||
Nonprescription drugs: | On Hand | Need to Acquire |
Aspirin and non—aspirin pain relievers | ||
Antidiarrheal medication | ||
Antacid | ||
Laxative | ||
Vitamins | ||
Syrup of ipecac | ||
Additional Specialty Items: | On Hand | Need to Acquire |
Family Disaster Plan Checklist | ||
Assemble these items in a disaster supply kit in case you need to leave quickly.
Tools | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
Portable, battery-powered radio, TV, alarm clock | ||
Flashlight and extra batteries | ||
Signal flare
Family Disaster Plan Checklist |
||
Matches in a waterproof container | ||
Shut-off wrench, pliers, shovel, hammer, screwdriver, and other tools | ||
Duct tape and scissors | ||
Plastic sheeting | ||
Whistle | ||
A-B-C fire extinguisher | ||
Tube tent | ||
Compass | ||
Work gloves | ||
Paper, pen, pencils | ||
Needles and thread Family Disaster Plan Checklist | ||
Additional Specialty Items: | On Hand | Need to Acquire |
Sanitation and Hygiene | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
Washcloth and towel | ||
Towelettes, soap, hand sanitizer, liquid detergent | ||
Toiletries | ||
Heavy-duty plastic garbage bags | ||
Medium–sized plastic bucket with tight lid and small shovel for digging a latrine. Family Disaster Plan Checklist | ||
Disinfectant and household chlorine bleach | ||
Additional Specialty Items: | On Hand | Need to Acquire |
Kitchen Items | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
Manual can opener | ||
Mess kits or paper cups, plates, plastic utensils | ||
All-purpose knife | ||
A dropper (eye dropper) with measurements | ||
Liquid bleach to treat water.
Family Disaster Plan Checklist |
||
Sugar, salt, pepper | ||
Aluminum foil, plastic wrap | ||
Resealing plastic bags | ||
Additional Specialty Items: | On Hand | Need to Acquire |
If food must be cooked, a small camping stove and can of cooking fuel | ||
Clothes and Bedding | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
One complete change of clothes and footwear for each member of the household. Shoes should be sturdy work shoes or boots. Family Disaster Plan Checklist | ||
Rain gear, hats and gloves, extra socks and underwear, thermal underwear, sunglasses. | ||
Blankets or sleeping bag and pillows for each member. | ||
Additional Specialty Items: | On Hand | Need to Acquire |
Specialty Items as needed for Baby | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: Family Disaster Plan Checklist | ||
Specialty Items as needed for Elderly | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: | ||
Specialty Items as needed for Pets | On Hand | Need to Acquire |
Check off all the basic items you have and list additional specialty items you have on hand: Family Disaster Plan Checklist | ||
Review other disaster preparedness websites for items not included here.
List items that you have added to personalize your emergency preparedness Go Bag. | |
Item | Included |
List items you need or would like to acquire to personalize your Go Bag. | |
Item | Included |
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