Earthquake Preparedness Forms

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Please print and forward:

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EARTHQUAKE PREPAREDNESS FAMILY REGISTRY FORM Family/household name:_____________________________________________ Address:___________________________________________________________ Phone (day/evening):_______________________________________________ E-mail address:____________________________________________________ Out-of-area contact person:________________________________________ Phone: ( )_______________________________________________________ ADULTS IN HOUSEHOLD 1. Name____________________________________________________________ Work hours:_____________________________________________________ Work address:___________________________________________________ Phone:__________________________________________________________ E-mail address:_________________________________________________ 2. Name____________________________________________________________ Work hours:_____________________________________________________ Work address:___________________________________________________ Phone:__________________________________________________________ E-mail address:_________________________________________________ CHILDREN Names Age/Grade School _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ MEMBERS OF HOUSEHOLD WHO MAY NEED SPECIAL ASSISTANCE IN AN EMERGENCY SITUATION Name Special Need/Type of Assistance Needed _________________________ ________________________________________ _________________________ ________________________________________ _________________________ ________________________________________ _________________________ ________________________________________ PETS Name Breed/Type Description In/Outdoors _________________ _________________ ________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ Copyright City of Oakland 1993 EARTHQUAKE PREPAREDNESS SPECIAL SKILLS/EQUIPMENT/RESOURCES FORM Household:_________________________________________________________ Address:___________________________________________________________ Special Skill/Training Name (Carpentry, electrical, plumbing, fire fighting, medical, etc.) ________________________________ _________________________________ ________________________________ _________________________________ ________________________________ _________________________________ ________________________________ _________________________________ ________________________________ _________________________________ We might be able to provide temporary housing for _____ displaced neighbors. We have a potential source of water for fire fighting (pool, hot tub, cistern, etc.): Yes_____ No______ Please complete this form and return in to your Division Supervisor Copyright City of Oakland 1993 Also, please fill out the Earthquake Preparedness Questionaire (1997) There is also more information here on Earthquake Task Force Rolls and Responsibilities. Forward printed forms to: 44th Street * Sally Thomas, 471-44th (658-9673) Laura Jackson (601-1580) Howard Lasseter (601-6729) Gloria Cobb (428-0827) 45th Street * Tom Wenzel, 416-45th (601-0574) Patrick Hickey (428-7633) Webster Street * Cathy Steirn, 4415 Webster (547-3193) John Goodwin (655-6727)

Website Navigation: News - Recent events of interest in the neighborhood Block Party - The 1997 Block Party is coming and here we have a place to share information about it. Crimewatch - This is a running report on the efforts of our local urban wildlife. Hopefully it will stay brief. Calendar - Meetings and events. Earthquake Preparedness Earthquake Questionaire