Family Disaster Plan Checklist NURS 431 Disaster Management
Name: Date: Revise Date:
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. See Appendix A in your text. (Veenema, 2009)
Assignment Instructions:
Complete the Family Disaster Plan Checklist
1. Complete all sections. Use yes, no, check marks or x’s for items you do have. Use need, for items you do not have at this time. 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 and public companies.
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 the “My Family’s Disaster Planâ€. Include your reference and in text citations.
My Family’s Disaster Plan
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 in text citation(s).
Possible hazards in my area # 1
Reference
Possible hazards in my area # 2
Reference
____________________________________________________________________________
Emergency Phone Numbers -Â (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. _____
For yourself, spouse, and significant other:
| Employer/School | Address | Phone # | Facility Contact Name |
For children:
| 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) ______
| Name | Contact Name | Phone | |
Identify two meeting places for your family in the event that you are separated.
Location near your home:
| Location | Address | Phone | |
Location away from your home (in the event you cannot return home):
| 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 | Phone | Address | |
Draw a floor plan of your home. Mark two escape route pathways from each room to each exit . You may use this space to draw your floor plan or imbed a photo. You may attach your drawing page to the end of this document ~OR~ Attach 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.)
______
Everyone in the house knows how, when and where to shut off utilities. ______
| Utility Name | Phone Number | Shut-Off Location/Main Controls at your residence |
| Electric | ||
| Water | ||
| Gas |
Evacuation Plan and Transportation
Extra gallon of gas ______
If you do not have a car, make plans with a neighbor or your local government agency to be evacuated.
| Neighbor/Local Government Agency | Phone Number | Address |
_____________________________________________________________________________
Property, Health, and Financial Well-being
Review property insurance policies for disaster policies. ______
Current ______ Appropriate to needs ______
Review life-insurance policies. ______
Current ______ Appropriate to needs ______
Review health insurance policies. ______
Current ______ Appropriate to needs ______
Review financial documents. ______
Emergency savings $______ Easily accessible, small cash savings $ ______
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 photocopied items that are safely stored |
| 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) | |
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