surveyPoint
<p title="HOA Emergency Preparedness Survey">HOA Emergency Preparedness Survey</p>
This survey is being conducted by the HOA to help assess the community's emergency preparedness in the event of a disaster, such as an earthquake.
Submit
<a target='_blank' style='color:#000000;' href='//www.esri.com/products/survey123'>Powered by Survey123 for ArcGIS</a>
<p style="text-align:center;"><br></p><p style="text-align:center;"><img src="data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iNjQiIGhlaWdodD0iNjQiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+PGcgZmlsbD0ibm9uZSIgZmlsbC1ydWxlPSJldmVub2RkIj48Y2lyY2xlIGZpbGw9IiMzMTg3MkUiIGN4PSIzMiIgY3k9IjMyIiByPSIzMiIvPjxwYXRoIGZpbGw9IiNGRkYiIGQ9Ik0yMi42NjEgMzAuMjQ2bDUuMTgyIDQuOTg3TDQxLjU1MiAyMiA0NSAyNS40NjEgMjcuNzQ3IDQyIDE5IDMzLjQ5OHoiLz48L2c+PC9zdmc+"></p><p style="text-align:center;"><br></p><p style="text-align:center;"><strong style="font-size:16px;">Great! Your data was sent successfully. Thanks.</strong></p>
Survey Completion Date:
*
This is a required question
Participant Name:
*
This is a required question
Participant Location:
*
e.g., address, street name, or nearest cross streets
This is a required question
Locate your residence on the map:
*
Note: If you would prefer to not locate your home, please use the nearest intersection/cross streets.
This is a required question
What type of residence do you live in?
Single family (house)
Multi-family (apartment, condo)
Other
Other
How many levels does your home have?
<p>Include the basement as a separate level (if applicable)</p>
Approximately what year was your residence built?
Picture of your residence
Note: This will help assess building materials and structural integrity. Be advised: For security reasons, please do not share pictures with personally identifiable elements such as house numbers or car license plates.
How many people live in your home?
What are the age ranges of the people who live in your household?
Check all that apply.
0-5 years old
6-17 years old
18-60 years old
> 60 years old
Safety check 1: Are televisions in the home secured?
*
e.g., secured to where they are located, such as the cabinet, table or wall
Yes
No
This is a required question
How are they secured?
...
Locks
Pad
Straps
Velcro
Safety check 2: Are computers in the home secured?
*
e.g., secured to where they are located, such as the desk or table?
Yes
No
This is a required question
How are they secured?
...
Locks
Pad
Straps
Velcro
Safety check 3: Are bookcases secured to the walls?
*
Yes
No
This is a required question
Safety check 4: Are large cabinets secured to the walls?
*
Yes
No
This is a required question
Is someone in the household trained in First-Aid?
Yes
No
Select items in your home that could be used in case of an emergency response
check all that apply
Axe
Batteries
Blowtorch
First-aid kit
Flashlight, candles, matches
HAM radio or AM/FM radio
Handheld radios
Ladder
Portable generator
Satellite phone
Saw
Shovel
Stockpile of food and water for 7 days
Tent
Town/city map
Wheelbarrow
Do you have an up to date emergency contact list or phone tree directory?
Yes
No
Do you have a current evacuation plan?
Yes
No
Do you have a local neighborhood or community disaster plan?
Yes
No
Additional comments:
<p>Please list other resource items that could be useful in an emergency</p>