Earthquake Plan
The road to earthquake safety begins with your family earthquake plan. Follow these eight steps to prepare your plan. Then display it where you can review it with members of your household.
Emergency locations. Sketch you home's floor plan on this
grid. Include symbols below for the safe and danger zones, supplies, utilities,
evacuation routes, and reunion sites.
Practice duck, cover and hold in the safe spots in every
room. The earthquake drill should be exercised every three months. List dates
practiced below.
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
Store
supplies and prepare earthquake kits
See Lists from
Home Sweet Home
Family day locations and medical needs. Discuss with your
family what to do and where to go when an earthquake strikes at home, school,
work, or wherever you regularly go during the day. List any allergies or
medication needs for each family member below.
| Person | Day Location | Meeting Place | Special Medication Needs |
Out-of-town contact: ____________________ Phone:
___________
Alternate contact: _______________________ Phone: ___________
Make
your home earthquake safe
| Inside your home: | The structure of your home | ||
Water heater Bookcases Cabinet Latches TV sets Armoire |
Lamps File cabinets Vases and trophies Microwave Computers |
Mirrors Artwork Appliances Glassware Shelf items |
House foundation Chimney Cripple wall Masonry |
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Know
where to find vital documents and account numbers
| Account/Policy Number | Where is Copy? | Original? | |
| Insurance Policies: | |||
| Home | |||
| Auto | |||
| Life | |||
| Disability | |||
| Driver's License/ID: | |||
| Green Card: | |||
| Credit Cards: | |||
| Bank Accounts: | |||
| Passport: | |||
| Location of Papers | Location of Papers | ||
| Household Inventory |
Birth and Death Certificates |
||
| Tax Returns | Marriage Certificate | ||
| Contracts | Crucial Phone Numbers | ||
| Property Deeds | Stocks and Bonds | ||
| Medical Consent Forms | Safe Deposit Key | ||
| Immunization Records | Treasured Pictures | ||
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Jobs after an earthquake.
Assign responsibility for the following jobs:
| Safety Action | Person Responsible | Safety Action | Person Responsible |
| Search for Injured/Trapped | Check on Neighbors | ||
| Check for Gas Leaks | Ensure Sipping/Snacking | ||
| Check Plumbing | Prepare First Meal | ||
| Care for Children/Dependents | Supervise Clean-up | ||
| Inspect for Damage | Ensure Medications Taken | ||
| Prepare for Evacuation | Corral Pets |
Consent to Treat a Minor
This form should include the following information about the child: name, birthdate, allergies or special medical conditions, and name of physician and dentist. It should contain the following statement and should be signed and dated by the parent or legal guardian:
I, being the parent of the above-named minor, do hereby appoint: ________________________________ to act in my behalf in authorizing any X-ray, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the above-named minor during my absence. This document may be relied on by any licensed physician, surgeon, dentist, or appropriate hospital representative. I authorize any hospital that has treated the above-named minor to surrender physical custody of the minor to my above-named agent.
Authorized signature: ______________________________
Date:_________________________________
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