2021 Disaster & Emergency Readiness Survey

The California Foundation for Independent Living Centers (CFILC), Disability Disaster Access & Resources (DDAR) program needs your help to document disaster and emergency-related successes and gaps in your community, including electricity company shutoffs. Please assist us by filling out this important survey and passing it on to others. Thank you for your feedback!

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* 1. What disability do you most identify with?

Deaf or Hard of Hearing

Blind or Low-vision

Intellectual or Developmental

Physical or Mobility

Chronic Health Condition

Mental health disability

Other (please specify):

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* 2. Which age group describes you?

Under 60

60 or over

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* 3. Does your disability require you to use electricity-powered medical equipment or assistive technology on a daily basis?

Yes

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* 4. If yes, what electricity-powered medical devices or technology do you require access to on a daily basis?

Power wheelchair or scooter

C-Pap or Bi-Pap machine

Oxygen Concentrator

Nebulizer

Communication device

Electric-powered bed or mattress

Home Dialysis Machine

Home Life-Support Equipment

Other equipment (Please fill in):

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* 5. Is your disability affected by the temperature of your environment?

Yes

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* 6. Does your disability require you to take medication that needs refrigeration?

Yes

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* 7. Does your disability require you to have access to refrigerated foods?

Yes

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* 8. Do you require the use of an elevator to access and leave your home?

Yes

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* 9. Do you use any of the following types of transportation options?

Drive self

Driven by others

Paratransit

Bus

Train

Uber/Lyft

Taxi

Not Sure

Other (please specify):

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* 10. Which best describes your current personal emergency preparedness level?

Prepared

Somewhat prepared

Not prepared

Not Sure

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* 11. Do you have a personalized emergency preparedness plan?

Yes

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* 12. If you experienced a disaster or emergency, including an electricity company shutoff that lasted anywhere between 4 hours to 3 days, what resources would you immediately need that you do not currently have access to?

At least 3 contacts (family or friends) that know they are your emergency contacts

Accessible/reliable transportation (to leave your home)

Go-Bag (important documents and items that you need to safely leave home for a few days)

Emergency preparedness supplies (to stay safely at home)

A place to go if temporary housing is needed

Shelf stable food that meets your dietary needs

A landline phone (in case your cell phone does not work)

A cell phone (in case you have to leave your home)

A written list of family and friends with their phone numbers

A generator with gas or propane (that you can operate independently if backup power is needed)

A portable backup battery (that you can operate independently if backup power is needed)

Backup refrigeration for medication or dietary specific foods

Fans or portable A/C

Portable heating

Medication refills

Incontinence supplies

Other (please specify):

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* 13. Compared to 2019, how prepared are you for a disaster or emergency including an electricity company shutoff this year?

I’m fully prepared

I’m somewhat prepared

I’m not prepared at all

Not sure

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* 14. Who is your electricity provider?

Pacific Gas and Electric (PG&E)

Southern California Edison (SCE)

San Diego Gas and Electric (SDG&E)

Other

Not sure

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* 15. Are you enrolled in your utility company’s medical baseline or critical care program?

Yes

Not sure

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* 16. Are you aware of the resources that your electricity company provides to people with disabilities and older adults to assist during electricity outages?

Yes

Not sure

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* 17. Are you in enrolled in your electricity company's electricity outage alert and notification system?

Yes

Not sure

Don't know how to enroll

Other (please specify):

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* 18. Are you enrolled in your county's emergency alert and notification system?

Yes

Not sure

Don't know how to enroll

Other (please specify):

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* 19. Please fill out if we can contact you to gather additional information:

Name

Email Address

Phone Number