Family Emergency Plan Worksheet

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S T E P S TO C R E AT I N G A

OUR FAMILY EMERGENCY PLAN

FAMILY FAMILY NAME ADDRESS HOME PHONE DATE UPDATED

EMERGENCY FAMILY MEMBERS

PLAN NAME AGE MEDICAL CONDITIONS PHONE EMAIL

NAME AGE MEDICAL CONDITIONS PHONE EMAIL


There are some things people naturally don’t like to discuss.
What your family should do in case of an emergency should not
NAME AGE MEDICAL CONDITIONS PHONE EMAIL
be one of them. Be prepared, teach your children to be prepared,
and take comfort in knowing that if disaster should strike, you
and your family will know what to do. NAME AGE MEDICAL CONDITIONS PHONE EMAIL

PETS

GETTING NAME TYPE DESCRIPTION REGISTRATION #

STARTED NAME TYPE DESCRIPTION REGISTRATION #

To get started with planning a family


emergency plan, you and your family
EMERGENCY CONTACTS
Keep a copy of this completed
should consider the following:
printout on your fridge and give
• Create a family emergency kit one to each member of your NAME RELATIONSHIP PHONE EMAIL

family to keep on their person –


• Create a pet emergency kit
be it in a backpack, wallet, or the NAME RELATIONSHIP PHONE EMAIL
• Maintain your family glovebox of a car.
emergency kits
• Complete this printout Consider putting together a NAME RELATIONSHIP PHONE EMAIL

disaster kit with essentials your


family would need in case of NAME RELATIONSHIP PHONE EMAIL
emergency.

OUT OF STATE CONTACT


*It’s important to identify a friend or family member outside of your immediate location to act as a point-of contact
in case of emergencies. During a disaster, it may be easier to make a long-distance phone call than a local one.

NAME RELATIONSHIP PHONE EMAIL


If we are separated during an emergency, what is our meeting place near our home?

MEDICAL INFORMATION Meet at the nearby Ministop convenience store five minutes away.

IN AN EMERGENCY,
REMEMBER TO
PHYSCIAN PHONE If we cannot return home or are asked to evacuate, what is our meeting place outside of
CALL 9-1-1 our neighborhood?
Unimart in Greenhills, San Juan.
PEDIATRICIAN PHONE

PHARMACY PHONE
What is our route to get to the above meeting place?

HEALTH INSURANCE GROUP NUMBER ID NUMBER


Shaw Boulevard to A. Mabini Street, exit at Wilson and followed until Unimart is
reached.
CLOSEST HOSPITAL ADDRESS PHONE
What is an alternate route if the first one cannot be used?
Shaw Boulevard to EDSA, exit at Ortigas Avenue towards San Juan City.
SCHOOL/CHILD CARE INFORMATION

NAME ADDRESS PHONE EMAIL TEACHER If we are directed to “shelter in place” at home, which room is the safest for us to go to seal
windows, vents and doors and listen to emergency broadcasts for instructions?
In the kitchen, where the refrigerator and food are. There is also a nearby toilet.
NAME ADDRESS PHONE EMAIL TEACHER Furthermore, we also have a portable radio that can pick up news signals or
broadcasts.

MOM & DAD’S WORK INFORMATION


TASK DESCRIPTION WHO IS
RESPONSIBLE?

NAME ADDRESS PHONE EMAIL TEACHER


Disaster Kit Periodically check stock. Take if evacuation is necessary. Robertson
Include items you might want to take to an evacuation
shelter. Remember to include medications and eye glasses.
(Dad)
NAME ADDRESS PHONE EMAIL TEACHER
Maintain access to NOAA or local radio, TV, email or text
Keep Informed
alerts for important and current information about disasters John
(Brother)
OUR PLAN OF ACTION Family Medical & Take all household medical info. Evacuate pet(s), keep a
phone list of pet‐friendly motels and animal shelters, and Olivia (Mom)
Pet Information
assemble and take the pet disaster kit.

The disasters most likely to affect our household are:


Typhoons, earthquakes, floods. Food shortages during an enhanced quarantine. Financial Get copies of bank statements and cash in the event credit
cards/ATMs don’t work due to power outages. Bring copies of Robertson
Information utility bills as proof of residence in applying for assistance. (Dad)
Share the completed plan with those who need to know. Meet
Sharing &
with household members every 6 months or as needs change Caitlin
Maintaining Plan to update household plan. (Sister)
Our disaster kit is located here:
In the kitchen.
ANY OTHER INFORMATION
Make sure to stock up on canned goods. Always check the go bag supplies if
What are the escape routes from our home?
they're up-to-date and unexpired.
1) Exit through the front door and out the gate and into the street.
2) Exit through the window and out the which leads to the main street.
CONGRATULATIONS! YOU’VE COMPLETED YOUR FAMILY DISASTER PLAN!
BE SURE TO TELL YOUR FRIENDS AND FAMILY TO DO THE SAME!

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