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How ready are you for a disaster? Clackamas County Social Services wants to know!  Your answers will help us create emergency preparedness information and materials. We are asking adults ages 55 years and older to complete this survey.

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* 1. What is your age? Check only one answer.

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* 2. How do you identify your ethnic or racial group? .

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* 3. Which language(s) do you speak at home? 

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* 4. Do you identify as: (Check only one answer)

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* 5. What type of housing do you live in? Check only one answer.

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* 6. What is the zip code of your home address? Leave blank if you do not have a home address. Write in your answer.

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* 7. Do you live in a rural area?

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* 8. Do you live alone?

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* 9. Are you the primary family caregiver for an older adult or a person with a disability?

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* 10. Do you have an emergency plan?

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* 11. In the event of an emergency, do you have a 3-day supply of stored drinking water?

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* 12. In the event of an emergency, do you have a 3-day supply of non-perishable food, like canned goods?

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* 13. In the event of an emergency, do you have a 3-day supply of your needed medications and medical supplies? Examples are diabetes blood glucose test strips, gloves, and incontinence supplies.

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* 14. Do you rely on medical devices that must be plugged-in, recharged, or require externally provided electricity? If yes, do you have a plan if the power is shut off for 3-14 days?

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* 15. In the event of an evacuation, do you have reliable transportation?

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* 16. Do you have one of more pets you are responsible for?

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* 17. If you answered yes to question 16, in the event of an emergency do you have a plan for how to transport and shelter your pets? Check only one answer.

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* 18. Do you have livestock you are responsible for?

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* 19. If you answered yes to question 18, in the event of an emergency do you have a plan for how to transport and shelter your livestock?

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* 20. Are you signed up to get emergency alerts and notifications from the county?

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* 21. If there is an emergency that requires immediate action, like a wildfire evacuation notice, how do you want to receive that information? Check all that apply.

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* 22. How do you want to get emergency preparedness information from the county? Check all that apply.

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* 23. During an evacuation that lasts more than 12 hours, where will you stay? Write in your answer.

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* 24. During an emergency, who will check on you? An example can be a family member, neighbor, or case manager. Write in your answer.

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* 25. During an emergency, who will you call for help?  An example can be a family member, neighbor, or case manager. Write in your answer.

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* 26. Select the level of concern you have for Extreme Heat

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* 27. Select the level of concern for Earthquake

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* 28. Select the level of concern for Winter Storm

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* 29. Select the level of concern for Flooding / dam failure

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* 30. Select the level of concern for biohazard

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* 31. Select the level of concern for Wildfire

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* 32. Select the level of concern for Landslide

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* 33. Select the level of concern for Volcanic Eruption

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* 34. Select the level of concern for Terrorist attack

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* 35. We want to learn from you! Do you have experience with past disasters and emergencies? If so, what did you learn? Write in your answer.

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* 36. Thank you for your participation.

Don’t want to wait for us to contact you! Go to ready.gov to see readymade emergency preparedness materials any time. Do you want to learn more about how to be prepared? Fill out your name, address, and email address below to get preparedness information from Clackamas County. This is optional. Your personal information will not be shared with anyone outside of Clackamas County.

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* 37. County staff only:

0 of 37 answered
 

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