TAKE THE SURVEY

How prepared are you in case of a fire, gas leak or an area wide evacuation?  What if you were required to shelter in place for an extended period of time?  Do you have a plan for both you and your pets?  This survey is for anyone 60+ living in a single family home in the 9 cities that we serve.

<strong>TAKE THE EMERGENCY PREPAREDNESS SURVEY</strong>

    This Survey is for anyone 60+ living in a single-family home in Cleveland Heights, Highland Heights, Lyndhurst, Maple Heights, Mayfield Heights, Mayfield Village, Richmond Heights, Solon, or South Euclid.

    ANSWER THE QUESTIONS TO THE BEST OF YOUR ABILITY.  

    ARE YOU A CURRENT CARE MEMBER?
    YesNo

    1. What is your age?
    60-7071-8081-9090+

    2. What city do you live in?
    Cleveland HeightsHighland HeightsLyndhurstMaple HeightsMayfield HeightsMayfield VillageRichmond HeightsSolonSouth Euclid

    3. How many people live in your home?
    12More than 2

    4. Do you have a pet(s)?
    YesNo

    5. What type of home do you live in?
    Single Story or Ranch Style HomeColonial or Multi Level Home

    6. How many bedrooms does your home have?

    7. Does your home have any of the following?(Check all that apply)
    BasementAtticAttached GarageNone

    8. What type of smoke alarms do you have?(Check all that apply)
    Sealed BatteryStandard BatteryHard WiredInterconnectedDo Not Have AnyNot Sure

    9. Where are the smoke alarms located?(Check all that apply)
    Each bedroomSome of the BedroomsOn each floorSome of the FloorsBasementAtticGarageDo Not Have AnyNot sure

    10. How many years has it been since you have replaced your smoke alarms? (Check all that apply)
    less than 1 year ago1-1010+Do Not Have AnyNot Sure

    11. Where are your fire extinguishers located?(Check all that apply)
    KitchenEach FloorSome of the FloorsBasementDo Not Have AnyNot Sure

    12. Where are your carbon monoxide alarms located?(Check all that apply)
    Near the KitchenEach FloorSome of the FloorsBasementDo Not Have AnyNot Sure

    13. How often do you check for combustible gas leaks in your home?
    Only if I smell ItAnnuallyNeverNot Sure

    14. Where are the emergency power lights located in your home?(Check All That Apply)
    On Each FloorSome of the FloorsIn Each BedroomSome of the BedroomsIn the BasementDo Not Have AnyNot Sure

    15. How many times this past year has your home lost power?
    None1-34-6More than 6Not Sure

    16. Does your stove have an auto shut off feature?
    YesNoNot Sure

    17. Is there anyone in the home who is unable to self-evacuate?
    YesNoNot Sure

    18. Is there anyone in the home unable to hear an alarm?
    YesNoMaybe

    19. Do you have any interior or exterior doors that are difficult to open or are malfunctioning?
    YesNoNot Sure

    20. Do all of your bedrooms have a functioning egress window that you can exit from if necessary?
    YesNoNot Sure

    21. Have you ever received information about what to do if there was an area wide emergency whether it be in your state, county or city?
    YesNoNot Sure

    22. If there was an area wide emergency, how would you know?

    23. Where is the emergency shelter for your city?

    24. Which best describes your level of preparedness if there was an area wide evacuation or shelter in place emergency?
    Very PreparedSomewhat PreparedNot Prepared at allNot Sure

    25. How likely is it that you would participate in activities to help you be safer and more prepared for emergencies?
    Definitely YesVery LikelyMaybeUnlikelyDefinitely No

    Please prove you are human by selecting the cup.

     

     

     

     

     

    *The information provided on this website is for general informational purposes only and is not intended to replace or substitute any professional, medical or legal advice.  CARE receives public and private funding.  Community Partnership on Aging serves as our fiscal sponsor.  CARE currently serves the cities of Cleveland Heights, Highland Heights, Lyndhurst, Maple Heights, Mayfield Heights, Mayfield Village, Richmond Heights, Solon, and South Euclid.