Family Disaster Plan ChecklistNURS 431 Disaster Management

Family Disaster Plan Checklist NURS 431 Disaster
Management
Name: Date: Revise
Date:
One of the most important steps you can take in preparing for
emergencies is to develop a household disaster plan. This
involves creating a plan that identifies who you can contact in
an emergency, what each member of your family must do, and
how you can better prepare yourself for the situation. See
Appendix A in your text. (Veenema, 2009)
Assignment Instructions:
Complete the Family Disaster Plan Checklist
1. Complete all sections. Use yes, no, check marks or x's for
items you do have. Use need, for items you do not have at this
time. Use N/A, for items not applicable for your living
situation. Do not leave anything blank.
2. Remember to protect personal information by using
pseudonyms, or by providing only partial information
· Ex: Sister: Britley *****, phone: 724-***-****, email:
b********@yahoo.com
3. Use complete information for utility and public companies.
4. Review the rubric for more information on how the
assignment will be graded.
5. Please note: You are not required to purchase any items on
this list, however, take note of the items you are missing and
consider how it could impact your safety and survival in a
disaster.
6. Complete the “My Family’s Disaster Plan”. Include your
reference and in text citations.

My Family’s Disaster Plan
Research potential disasters that could occur in your
community. Select 2 (two) potential disasters and using about
25 words, examine how these potential disasters can impact you
as a nurse. Provide at least 1 reference for each potential
disaster. Use APA Style for your reference(s) and in text
citation(s).
Possible hazards in my area # 1
Reference
Possible hazards in my area # 2
Reference
_____________________________________________________
_______________________
Emergency Phone Numbers - (Program these into all phones and
post in a common area in the home.)
Address
Phone #
Police Department
Fire Department
Local Emergency Services
Local American Red Cross

Poison Help
1-800-222-1212
Healthcare Providers
· Doctor
· Dentist
· Other (add additional important personal contacts)
Employers and School Officials Contacts
I know the emergency response plans for employers and
schools. _____
For yourself, spouse, and significant other:
Employer/School
Address
Phone #
Facility Contact Name
For children:

Child’s Name
Child Day Care/Child School
Address
Phone #
Facility Contact Name
Family Communication Plan
Prepare a family communication plan so that each member of
the family can contact one another quickly. (Put 10 most
important numbers on a card in your wallet.)
· Everyone has a cell phone or calling card _____
· Young children know how to call (numbers are saved) ______
Name
Contact Name
Phone
Email

Identify two meeting places for your family in the event that
you are separated.
Location near your home:
Location
Address
Phone
Email
Location away from your home (in the event you cannot return
home):
Location
Address
Phone
Email
Pick at least 1 or 2 friends or relatives who live out of the area
for household members to call/email to say they are okay. (If
you want, add others as backup.)
Name

Phone
Email
Address
Draw a floor plan of your home. Mark two escape route
pathways from each room to each exit. You may use this space
to draw your floor plan or imbed a photo. You may attach your
drawing page to the end of this document ~OR~ Attach as a 2nd
document to your assignment submission(Do not submit the
document as a 2nd submission attempt. It will negate your 1st
submission attempt. Submit as an additional document in 1
attempt. If you still have questions on how to submit this
assignment, please ask before submitting.)
______
Everyone in the house knows how, when and where to shut off
utilities. ______

Utility Name
Phone Number
Shut-Off Location/Main Controls at your residence
Electric
Water
Gas
Evacuation Plan and Transportation
Extra gallon of gas ______
If you do not have a car, make plans with a neighbor or your
local government agency to be evacuated.
Neighbor/Local Government Agency
Phone Number
Address
_____________________________________________________
________________________
Property, Health, and Financial Well-being
Review property insurance policies for disaster policies. ______
Current ______ Appropriate to needs ______
Review life-insurance policies. ______
Review health insurance policies. ______

Review financial documents. ______
Emergency savings $______ Easily accessible,
small cash savings $ ______
Important Documents and Items Secured
Make sure you have copies of important documents and items
that can be stored in a fireproof watertight container.
Important Items
Check off photocopied items that are safely stored
Personal identification
Cash and coins
Credit card(s)
Extra set of house keys and car keys
Birth certificate
Marriage certificate
Driver’s license
Social Security card
Passport/visa
Wills
Deeds
Inventory of household goods (with photos & serial numbers)
Insurance papers

Immunization records
· Allergies
· Medications
Bank and credit card numbers
Stock/bonds
Emergency contact list (phone/address/email)
Local map and emergency shelter locations
Pet information
Additional:
_____________________________________________________
_________________________
Pet Arrangements
As per local and state health and safety regulations, pets are not
permitted in some shelters such as American Red Cross shelters.
Service animals are permitted.
Name of Veterinarian and Name of Local Animal Shelter:
Name of Veterinarian
Address
Phone
Email

Name of Local Animal Shelter
Address
Phone
Email
Names of pet friendly hotels/motels or friends/family out of the
area:
Name
Address
Phone
Email
_____________________________________________________
_________________________
Special Needs Assistance
Special needs assistance organization in community.
Name
Address
Phone
Email

Register with your local office of emergency services or fire
department.
Name
Address
Phone
Email
Consider ways to help neighbors who may need special
assistance (ESL/medical/living alone).
Name
Special Help Needed
Address
Phone
Create a network of neighbors, friends, relatives, coworkers to
aid you in an emergency

· Mobility escape chair in place _____
· High-rise/apartment arrangements for emergency evacuation
_____
· Extra wheelchair batteries, oxygen, catheters, medications,
food for service animals _____
· Caregiver identification information _____
· Medical bracelet, etc. _____
_____________________________________________________
________________________
Certifications
Stay current and up to date (e.g., CPR, ACLS, PALS, TNCC).
Certification
Date of Completion
Date of Renewal
_____________________________________________________
________________________
Disaster Supply Kit “Go Bag”
You and your family may need to survive on your own for 3
days or more. Consider having additional supplies for up to two
weeks confinement or shelter. You should prepare emergency
supplies for the following situations:

Go Bags
Make sure all family members know where the go bags are and
have access to them.
Home go bag _____
Pet go bag _____
Child go bag with special items for feeling safe and staying
occupied _____
Car go bag - 3-day supplies included with emergency roadside
equipment _____
Work go bag _____
Water Supplies
Stocking water supplies should be a top priority. Drinking water
in emergency situations should not be rationed. It is critical to
store adequate amounts of water for your household.
Check off all of the basic items you have and list additional
specialty items you have on hand:
Water
Change water every 6 months.
On Hand
Need to Acquire
Next water change _____________ (date)
Two quarts of water daily for drinking for each person in your
household
One gallon/week supply of water stored for sanitary and
cooking needs for your household.
Additional Specialty Items:
On Hand

Need to Acquire
Next water change _____________ (date)
Extra two quarts of water daily for children, nursing mothers,
and those who are ill and need more.
Safety Tip: Water Storage and Collection in an Emergency
· Do not store in glass containers or other containers that can
break.
· Do not rely on untested devices for decontaminating water.
· If you have a well or public water, follow treatment methods
provided by your public health service or water provider.
· Store water in a cool, dark place.
Food: Preparing and Emergency Supply
Food, unlike water may be rationed except for children and
pregnant women. No special food needed. Keep canned foods
and dry mixes stocked. Replenish food supplies every 6 months.
Use and replace. Store newer items in the back, older items in
front.
High energy protein foods
On Hand
Need to Acquire
Peanut butter
Trail mix
Granola bars
Peanuts

Hard candy
Boxed juices
Powdered milk
Dry fruits
On Hand
Need to Acquire
Add items you need for your family situation:
Infant foods
On Hand
Need to Acquire

Specialty diet foods
On Hand
Need to Acquire
First Aid Supplies
Assemble a first aid kit for your home. ______
Assemble a first aid kit for each vehicle. ______
Basic First Aid Supplies
On Hand
Need to Acquire
First aid manual
Sterile adhesive bandages, assorted sizes
Safety pins assorted sizes
Cleansing agents
Antibiotic ointment

Latex gloves (2 pair)
Petroleum jelly or other lubricant
2-inch and 4-inch sterile gauze pads (4 to 6 of each)
Triangular bandages (3)
Sunscreen
Scissors
2-inch and 3-inch sterile roller bandages (3 rolls each)
Tweezers
Needle
Moistened towelettes
Antiseptic
Thermometer

Tongue depressor blades (2)
Prescription medication list (ask your pharmacist about storing
prescription medications)
Extra pair or prescription eyeglasses or contacts
Nonprescription drugs:
On Hand
Need to Acquire
Aspirin and non—aspirin pain relievers
Antidiarrheal medication
Antacid
Laxative
Vitamins
Syrup of ipecac
On Hand
Need to Acquire

Tools and Emergency Supplies
Assemble these items in a disaster supply kit in case you need
to leave quickly.
Tools
On Hand
Need to Acquire
Portable, battery-powered radio, TV, alarm clock
Flashlight and extra batteries
Signal flare
Matches in a waterproof container
Shut-off wrench, pliers, shovel, hammer, screwdriver, and other
tools
Duct tape and scissors

Plastic sheeting
Whistle
A-B-C fire extinguisher
Tube tent
Compass
Work gloves
Paper, pen, pencils
Needles and thread
On Hand
Need to Acquire

Sanitation and Hygiene
On Hand
Need to Acquire
Washcloth and towel
Towelettes, soap, hand sanitizer, liquid detergent
Toiletries
Heavy-duty plastic garbage bags
Medium--sized plastic bucket with tight lid and small shovel for
digging a latrine.
Disinfectant and household chlorine bleach
On Hand
Need to Acquire
Kitchen Items
On Hand

Need to Acquire
Manual can opener
Mess kits or paper cups, plates, plastic utensils
All-purpose knife
A dropper (eye dropper) with measurements
Liquid bleach to treat water
· Only use regular, unscented chlorine bleach products that are
suitable for disinfection and sanitization as indicated on the
label. The label may say that the active ingredient contains 6 or
8.25% of sodium hypochlorite. Do not use scented, color safe,
or bleaches with added cleaners. If water is cloudy, let it settle
and filter it through a clean cloth, paper towel, or coffee filter.
Sugar, salt, pepper
Aluminum foil, plastic wrap
Resealing plastic bags
On Hand
Need to Acquire
If food must be cooked, a small camping stove and can of

cooking fuel
Clothes and Bedding
On Hand
Need to Acquire
One complete change of clothes and footwear for each member
of the household. Shoes should be sturdy work shoes or boots.
Rain gear, hats and gloves, extra socks and underwear, thermal
underwear, sunglasses.
Blankets or sleeping bags and pillows for each member.
On Hand
Need to Acquire

Specialty Items as needed for Baby
On Hand
Need to Acquire
Specialty Items as needed for Elderly
On Hand
Need to Acquire
Specialty Items as needed for Pets
On Hand
Need to Acquire

Other Items
Review other disaster preparedness websites for items not
included here.
Check off items that you have and list items you need to
acquire.
Item
Included
12 - Updated 2021 Summer 1
Emergency Bag out

The pictures I will share have similar items to what my go
bag contains. I prepared my bag-out bag after the wildfire
incident, Camp fire. I had to replace some things, such as food
and water. I choose to use the waterproof tactical backpack due
to its ability to have a waterproof pack. It is also huge, thus
benefit persons that want to carry a bag with them for hiking.
The tactical bag also provides ultimate organization experience,
thus enabling one to organize the backpack and its contents
within sufficiently. The essential items that I included in my
emergency go bag include
· 3 gallon of water (a mix of bottles and water pouches-which
came with a kit
· Perishable food (peanut butter, Beef Jerky, and Protein Bars
· Battery-powered Weather Radio with tone alert and extra
batteries for both
· Flashlight and extra batteries
· First aid kit
· Toothbrush and toothpaste
· Whistle to signal for help
· Dust mask, to help filter contaminated air and plastic sheeting
and duct tape to shelter-in-place
· Fire starter
· Moist towelettes, garbage bags and plastic ties for personal
sanitation
· Wrench or pliers to turn off utilities
· Can opener for food (to open canned food)
· Local maps
· Gloves
· Passport with other crucial documents
· Money
Accordingly, wildfire incidents in California have
increased in the past, with the recent event being the Camp Fire,
which occurred on November 8, 2018 (Cleve, 2018). The
incident caused deaths of about 88 civilians with three injured
firefighters. It also destroyed more than 10,321 structures, thus
being the fatal and most disparaging fire in California history

(Cleve, 2018). This was the closest fire incident to my
residential area. Residents in the area had no emergency escape
plan hence people were confused about what to do during the
event. I had to help them by informing them they need to have
an emergency kit with food, water, and essential items to
sustain them during such times. Also, I asked them to keep
relevant documents, including passport and certificates.
Since my bad was meant for a general emergency, I had to
update some of the items in it due to the fire incident. Within
the bag, daily items such as food, water, sleeping bag,
toothpaste and toothbrush, and first aid kit. In the pack, I have
included a copy of my crucial documents, such as birth
certificate and social security card. Due to limited space, I have
included multi-purpose items, including 3-in-one utensils with a
spoon, knife, and fork. The shovel contains various functions,
including whistle, can opener, and fire starter. Also, the bag
pack contains battery-powered Weather Radio with tone alert
and extra batteries for both and flashlight with extra batteries.
Having people with special needs seem to be difficult
during a disaster. Thankfully, we do not have people with
special needs in the family. Though, we have a pet that we have
trained it to follow off-leash. This becomes important,
especially when carrying something without holding onto the
string. The pet has an emergency bag out bag for emergency
preparation. It is an encumber harness with room for the pet
items. The difficult part might be the weight distribution on the
pet’s back. However, if the bag out becomes heavy, I still have
little extra space in my backpack.
In conclusion, my opinion is that I am prepared to assist
other community members in the event of an emergency. The
most probable challenge might be some would try to carry
unnecessary items in their bag out. In such an incident, it would
be difficult for them to move on time.
References
Cleve, W. (2018 November 26). The deadliest, most destructive
wildfire in California’s history has finally been contained.

Retrieved from
https://www.washingtonpost.com/nation/2018/11/25/camp-fire-
deadliest-wildfire-californias-history-has-been-contained/
This week you will put together your 72-hour disaster home "go
bag" and evaluate your preparedness.
Here are the steps for your initial post:
1. Use the lists available at the Ready.gov website, FEMA, or
the Red Cross website to gather items for your 72-hour home go
bag. Add additional items that you think will be useful and
essential for your family. (You are not required to purchase
items, but you may if you choose.)
2. Post a picture of all of the items you have gathered for your
go bag. For the sake of personal and family privacy, keep
personal/private items out of the photograph; you may list them
(e.g., prescription medications).
· You must take and submit a picture of your own items! You
may not post a picture from the internet or any other source.
Along with your photo, include the following information:
· A discussion of the items in your home go bag - what is
present and what is missing.
· A brief explanation of the demographic considerations and
potential disaster hazards in your area and why you included
certain items.
· Your family, pets, and living situation considerations and why
you included certain items.
· Are you prepared to help others in your community in the
event of a disaster?
Support your answers with evidence from scholarly sources.
In your replies to peers, you may:
· Make suggestions for items to add or additional go bag ideas
for children, pets, etc.
· Share ideas for cost-effective ways to add items.
· Ask questions about why some items are included, if it was
not explained in the post.

· Share additional websites and preparedness lists.
Example: “I felt it was interesting that you chose to include a
fishing pole. What else would you need to include to assure the
proper use of this tool? This is a resource that may not be useful
to everyone but in our area, we could benefit from this
important tool. According to Veneema…”
Additional Resources
How to Pack an Emergency Kit for Any Disaster
How to Put Together a Family Emergency Kit
For this assignment, you will complete Your Family's Disaster
Plan Checklist adapted from Appendix A of
your ReadyRN text.
This week you will gather and complete the recommended
information and supplies listed on the Family Disaster Plan
Checklist Checklist.
Please note: You are not required to purchase any items on this
list. However, take note of the items you are missing and
consider how it could impact your safety and survival in a
disaster.
a. Download the Family Disaster Plan ChecklistDownload
Family Disaster Plan Checklist
b. Complete all sections. For the inventory lists, use a check
mark to show which items you have on hand.
· For items that are not applicable to you and your living
situation, please write N/A (not applicable) in the space,
otherwise it will be counted as incomplete.
· Remember to protect personal information by using
pseudonyms, or by providing only partial information
· Ex: Sister: Britley *****, phone: 724-***-****, email:
b********@yahoo.com
Week 7 Discussion Forum

This week you will put together your 72-hour disaster home "go
bag" and evaluate your preparedness.
Here are the steps for your initial post:
1. Use the lists available at the Ready.gov website (Links to an
external site.), FEMA (Links to an external site.), or the Red
Cross website (Links to an external site.) to gather items for
your 72-hour home go bag. Add additional items that you think
will be useful and essential for your family. (You are not
required to purchase items, but you may if you choose.)
2. Post a picture of all of the items you have gathered for your
go bag. Make sure your name is included somewhere in the
picture (you can write your name on a piece of paper and
include that in the picture, or add your student ID badge). For
the sake of personal and family privacy, keep personal/private
items out of the photograph; you may list them (e.g.,
prescription medications).
· You must take and submit a picture of your own items! You
may not post a picture from the internet or any other source.
Along with your photo, include the following information:
· A discussion of the items in your home go bag - what is
present and what is missing.
· A brief explanation of the demographic considerations and
potential disaster hazards in your area and why you included
certain items.
· Your family, pets, and living situation considerations and why
you included certain items.
· Are you prepared to help others in your community in the
event of a disaster?
Support your answers with evidence from scholarly sources.
In your replies to peers, you may:
· Make suggestions for items to add or additional go bag ideas
for children, pets, etc.
· Share ideas for cost-effective ways to add items.
· Ask questions about why some items are included, if it was
not explained in the post.

· Share additional websites and preparedness lists.
Example: “I felt it was interesting that you chose to include a
fishing pole. What else would you need to include to assure the
proper use of this tool? This is a resource that may not be useful
to everyone but in our area, we could benefit from this
important tool. According to Veneema…”
Additional Resources
How to Pack an Emergency Kit for Any Disaster (Links to an
external site.)
How to Put Together a Family Emergency Kit

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