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Personal Emergency/Disaster Plan

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A personal disaster plan is important to have in place before an emergency or disaster occurs. Agency personnel will help you develop a plan. Additionally, you will be evaluated upon admission to determine your service and evacuation needs in the event of a disaster.

The reality of a disaster situation is that you will likely not have access to everyday conveniences. To plan in advance, think through the details of your everyday life. If there are people who assist you on a daily basis, list who they are and how you will contact them in an emergency. Create your own personal support network by identifying others who will help you in an emergency. Think about what modes of transportation you use and what alternative modes could serve as backups. If you require handicap accessible transportation, be sure your alternatives are also accessible. Make a plan and write it down. Keep a copy of your plan in your emergency supply kits and a list of important information and contacts in your wallet. Share your plan with your family, friends, care providers, and others in your personal support network.

Emergency Contact Information

Relatives

Enter information for each on separate line.

Friends/Neighbors

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My Medical Information

Name
Address
I have a Do Not Resuscitate (DNR) order:
If yes, please please upload document below.
Max. file size: 32 MB.
Examples include walker, CPAP, charger for wheelchair battery, etc.

Disaster Preparedness Checklist

____ Make a list of all medicines including over the counter medicines.

____ Have a list of telephone numbers for emergency. Be sure at least one of them is in another area. This should include family, neighbors, physicians.

____ Have a list of medical conditions, along with a list of any medical treatments required.

____ Put together a “go bag” for situations when you might have to leave home for safety. This should include a change of clothes, medicines, medical equipment and supplies, food, water, toilet paper, flashlight (with extra batteries), cash, house keys, and cell phone charger.

____ Label all medical equipment with your name.

____ Have supplies necessary if forced to stay home due to a disaster (food, water, first aid kit, medications, extra medical supplies if needed).

____ Notify your utility company of priority need for utilities if special medical equipment is being utilized such as oxygen.

____ Locate nearest emergency shelter.

____ Have important identification and insurance information easily accessible. Make copies and keep with other lists in plastic bags.

____ Make sign that reads “Evacuated” to leave on door in case of evacuation.

* All lists should be in plastic bags; lists and “go bag” should be easily accessible.

* If you take medicine or use a medical treatment on a daily basis, be sure you have what you need on hand to make it on your own for at least one week. You should also keep a copy of your prescriptions as well as dosage or treatment information. If it is not possible to have a week-long supply of medicines and medical supplies, keep as much as possible and talk to your pharmacist or doctor about what else you should do to prepare.

Emergency Supply Kit

Basic Supplies

Think first about the basics for survival – food, water, clean air, and any life sustaining items you require.

Water

  • In a disaster, water supplies may be cut off or contaminated. Store enough water for everyone in your family to last for at least 3 days
  • Store one gallon of water, per person, per day. This amount will be adequate for general drinking purposes
  • Three gallons per person, per day will give you enough to cook and for limited personal hygiene. Do not forget to plan for your pets
  • Children, nursing mothers, and sick people may need more water
  • During warmer months, more water may be necessary
  • Store water in food grade plastic containers (such as clean 2-liter soft drink bottles or heavy duty, reusable plastic water containers)
  • Store in a cool, dark place
  • Replace water every 6 months and label container with replacement date
  • If you buy bottled water:
    1. Keep water in its original container; don’t re-store a bottle once it’s been opened
    2. Replace water at least once per year
    3.  Label bottles with their replacement date
  • Treating water after a disaster:
    • If you run out of stored drinking water, stain and treat water from your water heater or the toilet reserve tank (except if you use toilet tank cleaners); you cannot drink swimming pool or spa water, but you can use it for flushing toilets or washing
      • Strain any large particles of dirt by pouring water through a couple of layers of paper towels or clean cloth
    • Next, purify water one of two ways:
      • Boil – bring to a rolling boil and maintain for 3-5 minutes. To improve taste, pour it back and forth between two clean containers to add oxygen back
      • Disinfect – If the water is clear, add 8 drops of bleach per gallon. If it is cloudy, add 16 drops. Shake or stir, then let stand 30 minutes. A slight chlorine taste and smell is normal.
  • Food

    • When a disaster occurs, you might not have access to food and/or electricity for days, or even weeks. Store enough food to provide for your family for at least 3 days
    • Store food items that are familiar (rather than buying special emergency food). Consider any dietary restrictions you may have.
    • Ideal foods are shelf-stable (no refrigeration required), low in salt, and do not require cooking (e.g. canned fruit, canned vegetables, peanut butter, jam, low sodium crackers, cookies, cereals, nuts, dried fruit, canned soup or meats, juices, and non-fat dry milk). Don’t forget Ensure if you use it.
    • Label a rotation date on any food container that doesn’t already have an expiration date on the package
      1. Most canned foods can be safely stored for at least 18 months
      2. Dry goods (e.g. cereal, crackers, cookies, dried milk, dried fruit) must be used within 6 months
  • Include baby food and formula or other diet items for infants or seniors
  • Store the food in airtight, pest-resistant containers in a cool, dark place
  • Include a manual can opener, food utensils, paper plates, plastic cups, and paper towels
  • After a power outage, refrigerated food will stay cold longer if you keep the door closed
    1. Food should generally be consumed within 4 hours
    2. Food in the freezer will normally remain safe for 2 days
    3. General Items

      • Dust mask to help filter contaminated air
      • Plastic sheeting and duct tape to shelter in place
      • Moist towelettes, garbage bags, and plastic ties for personal sanitation
      • Wrench or pliers to turn off utilities
      • Local maps
      • Battery-powered or hank crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
      • Flashlight and extra batteries
      • Whistle, horn, bell, etc. to signal for help
      • First aid kit
      • Prescription medications you take every day. You should periodically rotate medications to account for expiration dates

      Additional Items to Consider for your Emergency Supply Kit

      • Glasses
      • Extra batteries for oxygen, breathing devices, hearing aides, wheelchairs, radios
      • Pet foot, extra water or supplies for your pet or service animal
      • Copies of important documents insurance policies and bank accounts in waterproof, portable container (plastic bags)
      • Cash
      • Sleeping bag or warm blanket for each person
      • Fire extinguisher
      • Matches in waterproof container

      Storing Supplies

      Purchasing small amount of supplies each week is easy on the budget. Choose an appropriate and accessible place to store supplies. Many people use either a large plastic garbage can or a number of small ones.
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