For this assignment, you will complete Your Family’s Disaster Plan Checklist. You will gather and complete the recommended information and supplies listed on the Family Disast
For this assignment, you will complete Your Family's Disaster Plan Checklist.
You will gather and complete the recommended information and supplies listed on the Family Disaster Plan Checklist Checklist.
Please note: You are not required to purchase any items on this list. However, take note of the items you are missing and consider how it could impact your safety and survival in a disaster.
a. Download the Family Disaster Plan Checklist and fill out everything.
b. Complete all sections. For the inventory lists, use a check mark to show which items you have on hand.
- For items that are not applicable to you and your living situation, please write N/A (not applicable) in the space, otherwise, it will be counted as incomplete.
- Remember to protect personal information by using pseudonyms, or by providing only partial information
- Ex: Sister: Britley *****, phone: 724-***-****, email: b********@yahoo.com
Family Disaster Plan Checklist NURS 431 Disaster Management
Assignment Instructions:
Complete your Family Disaster Plan Checklist
1. Complete all sections I – VIII. Use yes, check marks or x's for items you do have. Use need or no for items you do not have currently. Use N/A, for items not applicable for your living situation. Do not leave anything blank.
2. Remember to protect personal information by using pseudonyms, or by providing only partial information.
· Ex: Sister: Britley *****, phone: 724-***-****, email: b********@yahoo.com
3. Use complete information for utility companies, public companies, and agencies.
4. Review the rubric for more information on how the assignment will be graded.
5. Please note: You are not required to purchase any items on this list, however, take note of the items you are missing and consider how it could impact your safety and survival in a disaster.
6. Complete Section I. – “My Family’s Disaster Plan-Potential Hazards”. Include your reference and in-text citations.
____________________________________________________________________________
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)
I. My Family’s Disaster Plan – Potential Hazards
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.
# 1-Possible hazards in my area:
Reference
# 2-Possible hazards in my area:
Reference
II. Emergency Contact Information and Communication Plan
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Emergency Phone Numbers – (Program these into all phones and post in a common area in the home.) |
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Address |
Phone # |
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Police Department |
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Fire Department |
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Local Emergency Services |
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Local American Red Cross |
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Poison Help |
1-800-222-1212 |
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Healthcare Providers |
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· Doctor |
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· Dentist |
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· Other (add additional important personal contacts) |
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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 |
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Child’s Name |
Child Day Care/Child School |
Address |
Phone # |
Facility Contact Name |
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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 |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
Identify two meeting places for your family, in the event you are separated.
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One Location NEAR your home (neighbor/local friend): |
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Location |
Address |
Phone |
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One Location AWAY from your home, in the event you cannot return home (school, recreation center, fire department, police station): |
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Location |
Address |
Phone |
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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.) |
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Name |
Address |
Phone |
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III. Emergency Floorplan, Utilities Shut-Off, Evacuation Plan and Transportation 1. Draw a floor plan of your residence and label all exterior doors and windows.
2. Mark two escape route pathways, using arrows, out of each room.
(See example below: Bastrop County Office of Emergency Management).
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· Use this space to draw your floor plan or imbed a photo OR
· You may attach your drawing to the end of this document OR
· Attach it as a 2nd document to your assignment submission. Do not submit the document as a 2nd submission attempt. It will negate your 1st submission attempt. Submit as an additional document in 1 attempt.
If you still have questions on how to submit this assignment, please ask before submitting.
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Emergency Floorplan |
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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 |
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Electric Company Name |
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Water Company Name |
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Gas Company Name |
Evacuation Plan and Transportation
· Extra gallon of gas ______
· If you do not have a car, do you have plans with a neighbor, family members or your local government agency to be evacuated. ______
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List a neighbor/family member or 2 and a local government agency. (Example: Area Rapid Transit) |
Address |
Phone |
IV. Property, Health, and Financial Well-being (yes/no answers)
· Review property insurance policies and disaster policies. Are current and appropriate to my/my family’s needs ______
· Review life-insurance policies. Are they current and appropriate to my/my family’s needs ______
· Review health insurance policies. Are they current and appropriate to my/my family’s needs ______
· Review financial documents. ______
· Appropriate emergency savings (an average of 3 months household income) ______
· Easily accessible, small cash savings ______
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Important Documents and Items Secured Make sure you have copies of important documents and items that can be stored in a fireproof watertight container. |
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Important Items |
Check off items that are safely stored/photocopied |
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Personal identification |
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Cash and coins |
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Credit card(s) |
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Extra set of house keys and car keys |
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Birth certificate |
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Marriage certificate |
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Driver’s license |
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Social Security card |
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Passport/visa |
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Wills |
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Deeds |
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Inventory of household goods (with photos & serial numbers) |
