Name

Address

Telephone Contacts

Number of family members / Ages

My family lives close to

There are overhanging trees close to our home

The following hazards can affect our home

Our house has a safe room/area from hurricanes

If a storm is approaching we will go to

Our important documents are located in one place

We have waterproof plastic containers to protect documents from water damage

We have a First Aid Kit at home

Family members who have taken First Aid Training

Disaster supplies we have at home

Family members who have taken Disaster Management Training

Medical conditions / physical challenges in the household

Medications used regularly at home

Type of water storage at home

We can store ____ gallons of water at home for emergency

Nearest Emergency Shelter

Closest Medical Facility

We have a Generator at home

Our house is insured against hazards

Emergency phone numbers posted in one/more places at home

District Disaster Management Coordinator

Coordinator’s contact number(s)

My family Muster Point is