Just print it out and give it to me when you're done! Or download a copy of the Survey here.
Springfield 4th Ward
PREPAREDNESS Survey
Debt
1. Are you debt-free? Y N
(If "yes", skip to section "Food Storage".)
2. Please complete questions indicating what type of debt you have:
a) home mortgage Y N
b) car Y N
c) credit card Y N
d) recreational vehicle(s) Y N
e) other Y N
3. Are you actively following a plan to become debt-free? Y N
4. Estimate how many years/months before you become debt-free: __________
Food Storage
5. Do you have a functioning home food storage program? Y N
6. Approximately how many gallons of water do you have stored (not including water heater, toilet tanks)? _____________
7. Approximately how many pounds of grain and/or legumes do you have stored (rice, wheat, etc)? __________
8. Are you using your storage items on at least a weekly basis? Y N
9. Are you currently storing rotating food supplies? Y N
(canned foods, boxed foods, condiments, etc)
10. Estimate how many months your family could survive on your overall food storage: _____________
Fuel Storage & Use
Please answer the following as if electricity/natural gas service is disrupted:
11. Do you have an alternative heating source? Y N
(wood burning stove, propane, etc.)
12. Estimate how many days of fuel for such heating you have stored: ________
13. Estimate how many hours lighting you have stored (candles, lanterns, generator, etc.): _________
14. Do you own an alternate cooking device? Y N
15. Do you own a dutch oven/outdoor cookware? Y N
Medical Supplies
16. Do you have a family first aid kit? Y N
Personal Hygiene
17. Do you have detergent/liquid laundry soap stored? Y N
18. Do you have liquid/bar hand soap stored? Y N
19. Do you have toilet paper stored? Y N
20. Do you have paper/cloth towels stored? Y N
Alternative Dwelling
21. Do you have an alternative dwelling? Y N
(tent, camper, trailer, etc.)
22. Do you have a 72-hour kit for each family member? Y N
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