POZ232_December

Be Prepared
When disaster strikes, will you be ready? It’s important to have a plan in place in case of an emergency. Depending on the situation, it may be difficult to access your meds and your health care provider. Take our survey and let POZ know how prepared you are in the event of a disaster.
1) In general, how prepared are you to handle an emergency situation?

I’m ready for anything.I’m somewhat prepared.I’m not at all prepared.
2) Do you keep an emergency supply of all your medications?

YesNo
3) Do you keep a copy of your medical records in a waterproof and fireproof container?

YesNo
4) Do you keep a copy of your financial records in a waterproof and fireproof container?

YesNo
5) Do you keep a copy of important phone numbers and passwords in a waterproof and fireproof container?

YesNo
6) Do you keep up-to-date electronic copies of your medical and financial information?

YesNo
7) Do you keep an emergency supply of food and water in your home?

YesNo
8) Do you keep a well-stocked and up-to-date first aid kit in your home?

YesNo
9) Do you have an evacuation action plan in case of an emergency?

YesNo
10) Have you shared your emergency plans with others

YesNo
11) Do you keep your emergency gear packed in an easy-to-carry bag or container?

YesNo
12) Do you keep a fire extinguisher in your home?

YesNo
13) Do you have a will?

YesNo
14) Do you have an advance health care directive?

YesNo
15) What year were you born?
16) What is your gender?

MaleFemaleTransgenderOther
17) What is your sexual orientation?

StraightGay/LesbianBisexualOther
18) What is your ethnicity? (Check all that apply.)

American Indian or Alaska NativeArab or Middle EasternAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
19) What is your annual household income?

Less than $15,000$15,000–$34,999$35,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 or more
20) What is your current level of education?

Some high schoolHigh school graduateSome collegeBachelor’s degree or higher
21) What is your zip code?
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Be Prepared