Creating a Family Disaster Plan

Step-By-Step Guide-Fill in the Blanks

Provided to you by Jefferson County Project Impact

The ____________ Family Disaster Plan

Last Updated _________________

Names of People in this Family:

Table of Contents

Our Designated Meeting Places…………………………………………………….

Our Designated Out of Town Contacts…………………………………………….

Floor Plan of Our Home……………………………………………………………

Emergency Telephone Numbers……………………………………………………

Neighbor’s Telephone Numbers……………………………………………………

Insurance Policy Information……………………………………………………….

Medical Information…………………………………………………………………

Disaster Supply Kit Checklists………………………………………………………

Family and Other Important Phone Numbers……………………………………….

Pets Information………………………………………………………………………

Our Designated Meeting Places

In the event of the need to immediately evacuate our house, or in the event that we come home and see the house in flames, it is important that we have a designated meeting place outside of our home so that we know that everyone is out and safe.

Our immediate outside place is………………………..________________

In the event that we would not be able to enter our neighborhood or had to leave our neighborhood for reasons such as a hazardous materials spill or other neighborhood evacuation,

Our meeting place outside of our neighborhood is…__________________

In the event that we would have to leave the entire vicinity, such as in the case of a national attack,

Our meeting place is ________________________________________

Our Designated Out of Town Contacts

In many emergencies, it is easier to contact someone out of town than to make a local call. For this reason, it is necessary to designate an out of town contact that we will call to let know our condition and our whereabouts in time of emergency when we may not be able to get in touch with each other.

Designated Out of Town Contact………………………………………..

Name_____________________________ Phone __________________

In the event that we cannot contact __________, the back up contact is:

Name_____________________________ Phone___________________

Floor Plan of Our Home

(Draw the Floor Plan of Your Home here. Designate 2 escape routes from each room)

Emergency Telephone Numbers

For All Emergencies……………………………………………..9-1-1

Jefferson County Office of Emergency Services………..304-728-3290

Jefferson County Emergency Communications Center... 304-725-8484

Poison Control Center…………….……………………304-388-4211

American Red Cross, Jefferson County Chapter……….304-725-5015

Salvation Army…………………………………………304-267-4612

WV State Police, Jefferson County……………304-725-9779 or cell *77

Jefferson County Sheriff…………………..……………304-728-3205*

Charles Town Police……………………………………304-725-2714*

Harpers Ferry Police……………………………………304-535-6366*

Ranson Police…………………………………………..304-725-2411*

Shepherdstown Police………………………………….304-876-6036*

Shepherd College Security…………………..304-876-5202 or 876-5374*

FBI………………………………………………...……..304-263-3421

US Marshal Service………………………...……………304-623-0486

US Secret Service………………………………………..304-347-5188

Jefferson County Health Dept (Environmental)….………304-728-8415*

Jefferson County Health Dept. (Clinic)………………..…304-728-8416*

Jefferson Memorial Hospital (Ranson)…………………304-728-1600

City Hospital (Martinsburg)…………………………….304-264-1000

Winchester (VA) Medical Center……………………….540-536-8000

Jefferson Urgent Care (Rt. 340, Charles Town)………..304-728-8533

Eastern Panhandle Free Clinic………………………….304-724-6091

WV Dept. of Heath & Human Services………………...304-725-3464

National Response Center (Chemical, Oil Spills, Chemical/Biological Terrorism)……………………………………………….800-424-8802

State Emergency Spill Notification…………………….800-642-3074

Blue Ridge Volunteer Fire Dept………………………..304-728-8006* or 304-725-8188*

Citizens (Charles Town) Vol. Fire Dept………………..304-725-2814*

Friendship (Harpers Ferry/Bolivar) Vol. Fire Dept…….304-535-2211*

Independent (Charles Town-Ranson) Vol. Fire Dept…..304-725-2514*

Shepherdstown Volunteer Fire Dept…………………….304-876-2311*

WV State Fire Marshal’s Arson Hotline…………………800-233-3473

Allegheny Power Emergency Number……………….…800-255-3443

Acct. # ______________________

Telephone ___________________________________________________

Cellular Phones _______________________________________________

TV Cable ____________________________________________________

For heating fuel, call __________________________________________________________________________________________________________________________

For propane, call _______________________________________________

Act. # __________________________

To pump septic tank, call __________________________________________________________________________________________________________________________

Water Pump Service __________________________________________________________________________________________________________________________

Other Important Numbers__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*Phone not manned 24 Hours. If no answer, call 725-8484. For ALL emergencies, call 9-1-1.

Emergency Alert System Radio Stations

In times of emergency, some radio stations are designated AES Stations. We should listen to these stations for emergency information, evacuation routes, sheltering information and other emergency information that needs to be relayed to us. Additionally, the County’s Plan calls for sirens to alert us to turn to one of the EAS stations. There will be fire trucks or other emergency vehicles to go through the neighborhoods with public address system notification for emergencies. If we hear the public address system, we should immediately turn to one of these stations for further information. The following are the EAS Stations near our home:

WEPM-AM 1340

WLTF-FM 97.5

Our Neighbor’s Telephone Numbers

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Name:_________________________________________________

Address________________________________________________

Phone Number__________________________________________

Our Insurance Policies

Health Insurance Information:

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Dental Insurance Information:

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Optical Insurance:

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Life Insurance Information

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information_____________________________________________________________________________________________________________________________________________________________________________________________________________________________

House Insurance Information

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Business Insurance:

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Vehicle Insurance Information

Company Name_______________________________________

Group Name or Number_________________________________

Subscriber____________________________________________

Subscriber Social Security #______________________________

Telephone Number_____________________________________

Other Information______________________________________________________________________________________________________________________________________________________________________________

Medical Information-(Name)____________

Doctor’s Name & Phone Number_______________________________

Dentist’s Name & Phone Number_______________________________

Pharmacy Name & Phone Number______________________________

Prescriptions:

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

Medical Information-(Name)___________

Doctor’s Name & Phone Number_______________________________

Dentist’s Name & Phone Number_______________________________

Pharmacy Name & Phone Number______________________________

Prescriptions:

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

RX # __________Drug Name & Dose___________ Dr. _______

Medical Information-Animals

Animal’s Name__________________________________________

Species:________________________________________________

Breed or Type:___________________________________________

Age as of _____________: __________

Sex_______________ Date Spayed or Neutered____________

Color/Markings:__________________________________________

Rabies Tag #_____________________________________________

Last Trip to the Vet________________________________________

Any illnesses or major surgeries________________________________________________________________________________________________________________________________________________________________________________

Veterinarian:___________________________________________________

Address & Phone_____________________________________________________________________________________________________________________

Pet-friendly hotel_______________________________________________

Boarding Kennel_______________________________________________

Animal Hospital for Boarding_____________________________________

Friend or pet sitter______________________________________________

Pictures of pet alone and with her/his family are attached.

Our Disaster Supply Kit Supplies

We may need to survive on our own for three days or more. This means having our own water, food and emergency supplies.

Assembling the supplies we might need following a disaster is an important part of our disaster plan. We should prepare emergency supplies for the following situations:

• A disaster supply kit with essential food, water, and supplies for at least three days—this kit should be kept in a designated place and be ready to “grab and go” in case we have to leave our home quickly because of a disaster, such as a flash flood or major chemical emergency. All household members know where the kit is kept.

• We need additional supplies for sheltering or home confinement for up to two weeks.

• We should also have a disaster supply kit at work. This should be in one container, ready to "grab and go" in case you have to evacuate the building.

• A car kit of emergency supplies, including food and water, to keep stored in your car at all times. This kit would also include flares, jumper cables, and seasonal supplies.

The following checklists will help us assemble disaster supply kits that meet the needs of our household. The basic items that should be in a disaster supply kit are water, food, first-aid supplies, tools and emergency supplies, clothing and bedding, and specialty items. We will need to change the stored water and food supplies every six months, so be sure to write the date you store it on all container.

We should also re-think our needs every year and update our kit as our household changes. Keep items in airtight plastic bags and put our entire disaster supply kit in one or two easy-to carry containers such as an unused trash can, camping backpack or duffel bag.

Water: the absolute necessity

 1. Stocking water reserves should be a top priority. Drinking water in emergency situations should not be rationed. Therefore, it is critical to store adequate amounts of water for our household.

• Individual needs vary, depending on age, physical condition, activity, diet, and climate. A normally active person needs at least two quarts of water daily just for drinking. Children, nursing mothers, and ill people need more. Very hot temperatures can double the amount of water needed.

• Because we will also need water for sanitary purposes and, possibly, for cooking, we should store at least one gallon of water per person per day.

 2. Store water in thoroughly washed plastic, fiberglass or enamel-lined metal containers. Don't use containers that can break, such as glass bottles. Never use a container that has held toxic substances. Sound plastic containers, such as soft drink bottles, are best. You can also purchase food-grade plastic buckets or drums.

• Containers for water should be rinsed with a diluted bleach solution (one part bleach to ten parts water) before use. Previously used bottles or other containers may be contaminated with microbes or chemicals. Do not rely on untested devices for decontaminating water.

• If your water is treated commercially by a water utility, you do not need to treat water before storing it. Additional treatments of treated public water will not increase storage life.

• If you have a well or public water that has not been treated, follow the treatment instructions provided by your public health service or water provider.

• If you suspect that your well may be contaminated, contact your local or state health department or agriculture extension agent for specific advice.

• Seal your water containers tightly, label them and store them in a cool, dark place.

• It is important to change stored water every six months.

Food: preparing an emergency supply.

 1. If activity is reduced, healthy people can survive on half their usual food intake for an extended period or without any food for many days. Food, unlike water, may be rationed safely, except for children and pregnant women.

 2. You don’t need to go out and buy unfamiliar foods to prepare an emergency food supply. You can use the canned foods, dry mixes and other staples on your cupboard shelves. Canned foods do not require cooking, water or special preparation. Be sure to include a manual can opener.

 3. Keep canned foods in a dry place where the temperature is fairly cool. To protect boxed foods from pests and to extend their shelf life, store the food in tightly closed plastic or metal containers.

 4. Replace items in your food supply every six months. Throw out any canned good that becomes swollen, dented, or corroded. Use foods before they go bad, and replace them with fresh supplies. Date each food item with a marker. Place new items at the back of the storage area and older ones in front.

 5. Food items that you might consider including in your disaster supply kit include: ready-to-eat meats, fruits, and vegetables; canned or boxed juices, milk, and soup; high-energy foods like peanut butter, jelly, low-sodium crackers, granola bars, and trail mix; vitamins; foods for infants or persons on special diets; cookies, hard candy; instant coffee, cereals, and powdered milk.

You may need to survive on your own after a disaster. Local officials and relief workers will be on the scene after a disaster, but they cannot reach everyone immediately. You could get help in hours, or it may take days. Basic services, such as electricity, gas, water, sewage treatment and telephones, may be cut off for days, even a week or longer. Or you may have to evacuate at a moment’s notice and take essentials with you. You probably won’t have the opportunity to shop or search for the supplies you’ll need. Your household will cope best by preparing for disaster before it strikes.

First aid supplies

Assemble a first aid kit for your home and for each vehicle:

• The basics for your first aid kit should include:

– First aid manual

– Sterile adhesive bandages in assorted sizes

– Assorted sizes of safety pins

– Cleansing agents (isopropyl alcohol, hydrogen peroxide)/soap/germicide

– Antibiotic ointment

– Latex gloves (2 pairs)

– Petroleum jelly

– 2-inch and 4-inch sterile gauze pads (4-6 each size)

– Triangular bandages (3)

– 2-inch and 3-inch sterile roller bandages (3 rolls each)

– Cotton balls

– Scissors

– Tweezers

– Needle

– Moistened towelettes

– Antiseptic

– Thermometer

– Tongue depressor blades (2)

– Tube of petroleum jelly or other lubricant

– Sunscreen.

• It may be difficult to obtain prescription medications during a disaster because stores may be closed or supplies may be limited. Ask your physician or pharmacist about storing prescription medications. Be sure they are stored to meet instructions on the label and be mindful of expirations dates—be sure to keep your stored medication up to date.

• Extra pair of prescription glasses or contact lens.

• Have the following nonprescription drugs in your disaster supply kit:

– Aspirin and nonaspirin pain reliever

– Antidiarrhea medication

– Antacid (for stomach upset)

– Syrup of ipecac (use to induce vomiting if advised by the poison control center)

– Laxative

– Vitamins.

Tools and emergency supplies

It will be important to assemble these items in a disaster supply kit in case you have to leave your home quickly. Even if you don't have to leave your home, if you lose power it will be easier to have these item already assembled and in one place.

• Tools and other items:

– A portable, battery-powered radio or television and extra batteries (also have a NOAA weather radio

– Flashlight and extra batteries

– Signal flare

– Matches in a waterproof container (or waterproof matches)

– Shut-off wrench, pliers, shovel and other tools

– Duct tape and scissors

– Plastic sheeting

– Whistle

– Small canister, A-B-C-type fire extinguisher

– Tube tent

– Compass

– Work gloves

– Paper, pens, and pencils

– Needles and thread

– Battery-operated travel alarm clock

• Kitchen items:

– Manual can opener

– Mess kits or paper cups, plates, and plastic utensils

– All-purpose knife

– Household liquid bleach to treat drinking water

– Sugar, salt, pepper

– Aluminum foil and plastic wrap

– Re-sealing plastic bags

– If food must be cooked, small cooking stove and a can of cooking fuel

• Sanitation and hygiene items:

– Washcloth and towel

– Towelettes, soap, hand sanitizer, liquid detergent

– Tooth paste, toothbrushes, shampoo, deodorants, comb and brush, razor, shaving cream, lip balm, sunscreen, insect repellent, contact lens solutions, mirror, feminine supplies

– Heavy-duty plastic garbage bags and ties—for personal sanitation uses—and toilet paper

– Medium-sized plastic bucket with tight lid

– Disinfectant and household chlorine bleach

– Consider including a small shovel for digging a latrine

• Household documents and contact numbers:

– Personal identification, cash (including change) or traveler's checks, and a credit card

– Copies of important documents: birth certificate, marriage certificate, driver's license, social security cards, passport, wills, deeds, inventory of household goods, insurance papers, immunizations records, blank and credit card account numbers, stocks and bonds. Be sure to store these in a watertight container.

– Emergency contact list and phone numbers

– Map of the area and phone numbers of place you could go

– An extra set of car keys and house keys.

–

Clothes and bedding

• One complete change of clothing and footwear for each household member. Shoes should be sturdy work shoes or boots. Rain gear, hat and gloves, extra socks, extra underwear, thermal underwear, sunglasses.

• Blankets or a sleeping bag for each household member, pillows.

Cat Supplies

-Cat Food

-Litter

-Litter Pan

-bags for old litter

-cat collar

-cat carrier

-leash

-rabies tag & medical information

-towel for inside of carrier

-flea spray

-cat comb

-cat