Your Family Emergency Plan Worksheet

Post your completed worksheet in a visible place for quick reference by family members, guests, and babysitters. It may help save a life! Emergency Communications Plan . . .

Emergency Contacts Out of Area Contact Person

Post these numbers next to all phones. If you or your loved ones are separated during a disaster, each Review with all family members. person should call the designated contact person to report his/her Carry this information in purse, briefcase, glove box, location and condition. This contact should be out-of-state because it is often easier to call long distance after a disaster. etc. Name ______Family name ______Address ______Home phone______Cross street______Cell phone______Home phone(s) 1.______2.______e-mail ______Work phone(s) 1. ______2.______Doctor ______Youth Plan Doctor ______ Make certain your child’s school or child care Neighbor ______provider’s emergency contact card is accurate and Neighbor ______up-to-date. Neighbor ______ Notify the adults you authorize, of any special Our children: medical or dietary requirements your child has. Name______Age____ _School______ Let your child know who will make the pick up at school or child care if you are unable to do so. Name______Age____ _School______ Keep emergency supplies in your car, including Name______Age____ _School______comfortable shoes, water and warm jackets. Designate an out-of-state contact to relay family Local family contact emergency information. Home phone______ Bring photo ID with you to pick-up your child. Work phone______Cell phone ______Emergency Alert System

For emergency information: Call 9-1-1 ONLY in case of life-threatening emergency or fire. Tune your radio to: KGO 810 AM KCBS 740 AM KNBR 680 AM KKIQ 101.7 FM Local emergency information: 1610 AM 1 © Updated and Revised 2011 San Ramon with Permission from EBMUD & Chevron Corp. Escape Route & Utilities Plan

Use this page to draw a floor plan of your house. Make a floor plan for each story of your home. Indicate primary exits from each room (doors, windows) and include location of escape ladders, ropes, etc. Identify location of emergency supplies. Mark location of utility valves, circuit breakers or fuses. Be sure all family members know where utilities are and how to turn them off. Be sure all family members know how to use a fire extinguisher. Share your plan with visitors. Family will reunite at our family meeting spot located at ______ ______

This material was originally developed by Chevron Corp, USA, modified by EBMUD in 1999, and used with permission. The materials present standard information available on prepar- ing for emergencies. Every reasonable effort has been made to ensure the accuracy of the material. The authors do not assume responsibility nor liability in how the reader uses the information on the effect of any recommended practice, procedure or product specified in the handout.

For all emergencies, remember to: If you were told to evacuate, what do you take? Stay calm & evaluate your surroundings. Personalize the following list, if you had to leave in: Turn your portable radio on and listen for instructions. 5 minutes: Check for injuries (for life threatening injuries only, Item Location call 9-1-1). Locate flashlights & emergency supplies. Radio Wear protective clothing (gloves, goggles, etc.). Address books Vital medication Earthquakes and Aftershocks Supplements Duck, cover and hold. Emergency Supply Kit/food Move away from windows, bookshelves, cabinets, Important documents and exterior walls. Business/computer records If indoors “ride it out” until the shaking stops. Damp towel for the smoke Pay attention to damaged utilities. Shut off those Pets utilities that are damaged. Pillow Check for structural damage. Special needs supplies Check on neighbors. ______ Prepare for aftershocks. ______ Keep streets clear for emergency traffic. ______Fire Stay calm - alert neighbors. 60 minutes (1 hour): For fires less than 3ft tall use your fire extinguisher. Stay out of a burning building. Item Location Photo albums, negatives Shelter in Place Vital documents If outdoors, go indoors; if indoors, stay put. Business records Keep pets indoors. Financial records Bring your family disaster supply kit indoors with Stocks and bonds you. Fire extinguisher Close all doors, windows and chimney flues. Computer and/or hard drive Turn off all fans, heating and air conditioning Camera systems. ______ Use duct tape and plastic sheeting to seal areas ______where outside air can enter the house. Tune your radio to the emergency broadcast sta- ______tion and listen for instructions. Evacuation If you have a car or truck: Evacuate if told by authorities. Item Location Take emergency supplies. Family heirlooms If time permits: Clothing • Take items listed in next column. Computer • Close windows, blinds, and doors. Original art • Shut off damaged utilities. Pet supplies Lock doors and windows when leaving. ______ Listen to your local radio station for shelter sites. ______If time permits, leave a note on theinside of your ______front door, to let others know where 3 you have evacuated. © Updated and Revised 2011 San Ramon with Permission from EBMUD & Chevron Corp. Emergency Supplies Plan Fire Hazard Mitigation Plan

We have food for family members and pets for Protecting lives from fire 3 - 7 days. We have at least one A-B-C fire extinguisher in our We store camping gear in one place. Tent, home and know how to use it. lanterns, sleeping bags and stove can double as We have changed the batteries in our smoke emergency equipment; if possible store it with detectors. your other emergency supplies. We use surge protectors as to not overload our Each family member has completed and is electrical outlets. carrying a wallet size “My Pocket Emergency We store flammable liquids in air-tight containers Plan”. away from ignition sources such as pilot lights. We have car and workplace mini-survival kits. (Example location: outdoor shed) We have additional supplies in: ______Landscaping against fire (Place) We have cleared our property of excess and dead We have a minimum of 2 gallons of water per vegetation and highly flammable plants. person per day for at least 3 -7 days. The more We have trimmed branches that hang over our water you can store, the better off you will be. home. Calculate how much water your family needs: We trim grass and vegetation at least 100 feet around our home. ___people/pets in household x 2 gals = _____ gals. We have garden hoses connected to outside faucets. I know where I have: We store firewood away from our house. Cash and coins. First aid items. Home maintenance Flashlight, radio, tools and sanitation supplies. Our house numbers are large and easily read from the street. Maintenance Plan We have spark arresters on our chimneys. Our roof is fire-retardant. Every six months: Date last checked We keep leaves and debris out of our rain gutters. Check and replace as needed: Batteries for flashlights, smoke detectors, radio, etc. ______Earthquake Mitigation Plan Review family plans. ______Conduct a fire drill. ______Surviving the event Rotate water supply. ______ My family and I have reviewed the information Every year: on the www.usgs.gov website for reducing Rotate canned goods. ______earthquake damage. Update school release forms. ______Replace emergency medications. ______Home preparedness We have attached the necessary tools to the Every two years: utility shut-off valves. Review and photograph personal We have done a home hazard hunt and property inventory. ______corrected hazards we found. Update insurance policies. ______

Every three years: Replace non-fat dry milk. ______Replace freeze-dried foods. ______