Copy and Paste this form into a Word Document. Enter vital information so your Family Plan will be easier to follow when needed.
Evacuation zone we live in: _____________________________
Where we will go if we need to evacuate? __ Shelter __ Friend __ Relative
Name ____________________ Address _________________ Phone
Have I notified my out-of-state contact of our plans? __ Yes __ No Name _______________________________ Address _______________________________ Phone _______________________________
Is my employer aware of my family plan and have my emergency contact information? __ Yes __ No
Does a member of my family require life support equipment? __ Yes __ No If yes, what plans have been made for them? _______________________________
Does a member of my family require a Special Needs Shelter?__ Yes __ No If yes, which Special Needs Shelter? Name _______________________________ Address _______________________________ Phone (Special Needs Shelter Registration) _______________________________ Medical Supplies Needed: _______________________________
Are my important documents properly secured? __ Yes __ No
What will I do with my pet(s)? If I go: _______________________________ If I stay: _______________________________
What preventive measures will I take to safeguard my home? • Window protection purchased? __ Yes __ No • Address clearly marked on house? __ Yes __ No • Hurricane-resistant garage door? __ Yes __ No • Roof reinforced? __ Yes __ No • Generator? __ Yes __ No • Identified safe-room: _____________________ • Have I purchased Must-Have Supplies? __ Yes __ No
Have we reviewed our insurance coverage? __ Yes __ No
