How Prepared Are You?

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

FIRST NAME(optional)

LAST NAME(optional)

EMAIL(optional)

PHONE(optional)

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

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