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1. Have you ever personally been involved in an emergency situation before as a result of:
1.a.When was the most recent time that you experienced one of the emergency situations listed in #1? choose one Within the past year 1-5 years 6-10 years 11-20 years 21-40 years 41 + years
2. Have you ever been in an emergency situation when YOU:
3. How likely do you think the following different emergency situations are to happen in our community in the next two years?
Natural Disaster choose one Definitely Will Probably Will Probably Will Not Definitely Will Not
Terrorist Attack choose one Definitely Will Probably Will Probably Will Not Definitely Will Not
Public Health Emergency choose one Definitely Will Probably Will Probably Will Not Definitely Will Not
4. If you were instructed by government officials to evacuate to outside the metropolitan area, would you: choose one Have NO place to stay AND NO transportation Have a place to stay AND have transportation Transportation, BUT NO place to stay Have a place to stay, BUT NO transportation
5. If you were instructed by government officials to evacuate your home to a shelter that could be reached by walking or public transportation, how LIKELY would you be to do so? choose one Definitely Would Very Likely Somewhat Likely Somewhat Unlikely Very Unlikely Definitely Would Not Have special needs that may prevent evacuating
5.a. Why would you be UNLIKELY to evacuate? To protect my home Concerned about my possessions Have people in my care Concerned about my pets Concerned about crime/danger Concerned about food/water/supplies in shelter Not able to get to shelter Have alternate place to go Not knowing locations of public emergency shelters Lack of trust in government Personal illness Dislike of crowds Lack of transportation Home could withstand event Have special needs that may prevent evacuating
6. Is there a tornado warning siren or some other emergency alert system in your community? choose one Yes No Don’t Know
7. Does your local government have an emergency or disaster plan for your community? choose one Yes No Don’t Know
8. Does your local government have an evacuation plan? choose one Yes No Don’t Know
9. Have you ever heard of the Office of Emergency Management in Nashville? choose one Yes No
10. In the past 30 days, have you seen or heard any messages that encourage people to take steps to be prepared for emergency situations in your community? choose one Yes No
11. Do you watch Metro 3 Government Access TV? choose one Yes No Didn’t know it existed, but will now
12. What would you suggest as the best way for emergency messages to reach you? choose one TV/news TV/Government Access Channel E-mail Internet Mass telephone calls Radio stations NOAA Weather Radio Highway Message Boards Other
If Other:
13. Would you and/or a family member take emergency preparedness classes at no cost to you? choose one Yes No Maybe
14. How confident are you with your LOCAL government being prepared for major emergencies such as natural disasters or terrorist attacks? choose one Very confident Somewhat confident Not confident Don’t want to answer
15. What would be the best way to get information to you about emergency preparedness, free classes, seminars etc? choose one TV/News TV/Government Access Channel Newspaper - Tennessean Newspaper - City Paper Newspaper - Nashville Business Journal Newspaper - Other Email Radio Internet Other
If Other: If Email:
16. Are you or anyone in your household a part of an active Neighborhood Watch Group? choose one Yes No
If no, would you be interested in joining one? choose one Yes No
17. Do you know how to report suspicious criminal/possible terrorist activity, or who to call? choose one Yes No Wouldn’t report it
18. Here is a short list of things that some people have done to prepare in the event of an emergency situation. What, if any, have you done to prepare? Prepared a disaster supply kit for the home Prepared a small disaster supply kit for the car Prepared a small disaster supply kit for the office Created a communication plan for family Created a meeting location for family Practiced drills at home Taken a first aid class Volunteered for emergency preparations (such as emergency drills etc) Other Nothing
19. If you have prepared a disaster supply kit for your home, which of the following do you currently have in your kit at home: 3 day supply of medicines Extra Batteries Flashlight 3 day supply of water 3 day supply of food First Aid Kit Weather Radio Standard AM/FM radio
19.a. When was the last time you or a family member checked and/or updated the items in your disaster supply kit? choose one Within the last month 2 - 6 months ago 7 - 12 months ago More than a year ago
20. If you do currently have a family communications plan, when was the last time you updated this plan and talked with your family about how you would communicate in an emergency? choose one Within the last month 2-6 months ago 7-12 months ago More than a year ago
20.a. Does your plan to communicate with family members in an emergency include a specific person living outside your community that everyone knows to contact if they become separated? choose one Yes No N/A
21. Here are some reasons that people often say for NOT doing things to prepare for an emergency situation like a terrorist act or natural disaster. Thinking about yourself, please indicate if any of the following is a MAJOR reason you haven’t done more. Don’t think an emergency will happen here Don’t know how to prepare Have not thought about it enough Nothing would be effective Cost too much money Takes too much time Don’t want to think about it Don’t have room for an emergency kit
22. Thinking about yourself, please tell us if any of the following is a MAJOR reason you are well prepared: Live in a high risk area Am responsible for children Been through emergency before Am responsible for elderly/disabled I think it is important to be self-sufficient
23. If an emergency situation were to occur, who would you likely call for more information? choose one 9-1-1 Non-emergency 862-8600 Red Cross Emergency Management City Hall News Stations Community hotline as told on TV Other None, would look for some other way of getting information
24. Do you know how to turn off your utilities such as gas, electricity or water? choose one Yes No
25. Are you currently: choose one Employed full time Employed part time Self employed Not employed
25.a. How many people work at your specific office or place of business (best guess): choose one Under 10 10-50 51-100 101-250 251 or more Varies
25.b. Does your employer have a detailed plan for how to respond in different emergency situations? choose one Yes No Don't Know
25.c. Does your employer have emergency supplies like non-perishable food and water in case employees must shelter in place at work? choose one Yes No Don't Know
25.d. Has there been any actual practice or drill of this plan at work in the last 12 months, or not? choose one Yes No Don't Know
26. How many children in your household go to daycare or school up through high school? choose one None 1-2 3-4 5 +
26.a. Does your child’s school or day care facility have a written plan for how to respond in different emergency situations? choose one Yes, all do Yes, some do No Don’t know
26.b. Has there been any actual practice or drills of this plan at school within the last 12 months? choose one Yes, all have Yes, some have No Don’t know
26.c. Does the school have emergency supplies like non-perishable food and water in case students must shelter in place at school? choose one Yes No Don't Know
26.d. Has your family received any information about this plan (or any part of it) the schools have within the last 12 months? choose one Yes No Don't Know
27. Including yourself, how many people are currently living in your household? choose one 1 2 3 4 or more Don’t want to answer
28. Do you have anyone staying in your household that has special needs that may need assistance during an emergency situation? choose one Yes No
29. What is your age? choose one 18-24 25-34 35-44 45-54 55-64 65+ Don’t want to answer
30. What is your gender: choose one Male Female Don’t want to answer
31. What is your zip code:
32. What is the highest grade of school or year of college that you have completed? choose one None Less than high school High school/GED Some college/Vocational College Graduate Post Graduate Don’t want to answer
33. What is your race? choose one African-American American Indian/Alaskan Native Asian/Pacific islander Caucasian Hispanic/Latino Inter-racial Other Don’t want to answer
