Corps of Engineers Civil Works Questionnaires Generic Clearance

EVACUATION QUESTIONNAIRE FOR RETIREMENT HOMES AND OTHER LONG TERM CARE FACILITIES

(Mail Questionnaire)

OMB 0710-0001

Expires: 30 September 2012

The public report burden for this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this data collection, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, Attn.: Desk Officer for U.S. Army Corps of Engineers. Respondents should be aware that notwithstanding any other provision of law, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Please DO NOT RETURN your completed form to either of these offices.

Evacuation QUESTIONNAIRE FOR RETIREMENT HOMES AND OTHER LONG TERM CARE FACILITIES

Thank you for taking the time to complete this survey. Your answers will provide Civil Defense Agencies with very valuable information that they need to develop safe and effective education and evacuation plans. The questionnaire may appear long, but it moves very quickly. We ask you about your awareness and experience with hurricanes and tsunamis, and a few questions about your facility and your facility’s evacuation plans, if any.

Please also understand that this survey is being completed by very large as well as very small care facilities. If the questions seem irrelevant to your establishment, feel free to add notes on the backs of the questionnaire form. It shouldn’t take more than 15 minutes to complete.

There are no wrong answers; your answers will be aggregated with many other responses from care facilities throughout the island.

HURRICANE AWARENESS

Civil Defense classifies hurricanes in five categories based primarily on the speed of the winds that make up the hurricane. These are listed below:

Category 1	74-95 mph winds
Category 2	96-110 mph winds
Category 3	111-130 mph winds
Category 4	131-155 mph winds
Category 5	155 mph winds and above

As examples, Hurricane ______ that struck the islands in _______ was a Category 2 hurricane, Hurricane ________ that struck in _________ was a Category 4 hurricane and Hurricane Katrina that struck New Orleans in 2005 was, at its worst, a Category 5 hurricane.

1. How much damage do you think your facilities would suffer in a Category 1 hurricane? (Fill in the circle for the appropriate answer)

Major damage ○

Minor damage only ○

Not sure ○

2. How much damage do you think your facilities would suffer in a Category 5 hurricane?

Major damage ○

Minor damage only ○

Not sure ○

3. What are the primary reasons for your assessment for how well your facilities would hold up to a hurricane? (fill in the circle for all answers that apply)

Your experience with other hurricanes ○

The construction quality of the facilities ○

The history of damage in _______ from hurricanes ○

Another reason; please specify___________________ ○

4. If you were told that a hurricane were approaching your community, for each category of hurricane, please tell us whether you would keep your residents at the facility or seek safe shelter elsewhere. (please fill in the appropriate circle in each column)

	Category of Hurricane
	1	2	3	4	5
Keep residents in place	○	○	○	○	○
Seek other shelter	○	○	○	○	○
Don’t know	○	○	○	○	○

5. Where is the closest shelter to which you might evacuate if you chose to do so?

Name or address: ____________________________ ○

I’m not sure where the closest shelter is located ○

6. Do you believe that you have enough information so that you know how to respond in case of a hurricane alert or warning?

Yes, I have enough information and am prepared to

respond ○

I have enough information, but I am not well prepared

to respond ○

I am somewhat aware, but I could use more information ○

I do not know enough information about how to respond ○

7. From whom have you learned the most about hurricane preparation? (please mark the TWO most important)

Civil Defense Agencies ○

Our care home system ○

Weather Service ○

External colleagues ○

The community ○

Television and radio ○

Newspapers ○

EMERGENCY RESPONSE

8. What is the best way to alert you to an approaching emergency? (please mark the two best methods)

Civil defense sirens ○

Alerts directly from Civil Defense ○

Radio announcements ○

Television announcements ○

Internet announcements ○

Text messaging ○

Other ways, please specify___________________ ○

9. Once a month, the County Civil Defense tests their outdoor emergency siren system. When that occurs, can you hear it from your facility?

Yes, I can hear it clearly ○

Yes, but I can barely hear it ○

No, I can’t hear it ○

10. hen you do hear it, do you typically turn on your radio or television?

Yes, I immediately turn on my radio or television ○

No, I typically ignore it ○

No, but I call other colleagues ○

No, but I get on the computer to see what is happening ○

No, but I do other things to find out ○

11. Does your facility use Sentinel or any other weather alert communication to provide direct, early warnings of approaching weather related emergencies?

Yes, we have weather alert communication ○

No, we do not have that capacity ○

12. If Civil Defense authorities RECOMMENDED that you evacuate your facilities because of an approaching hurricane or tsunami, how likely are you to evacuate your residents and staff? (Please mark one in each column)

	In Case of Hurricane	In Case of Tsunami
Very likely to evacuate	○	○
Somewhat likely to evacuate	○	○
Not at all likely	○	○

13. What if Civil Defense authorities were to REQUIRE that you evacuate your facilities, how likely are you to evacuate your residents and staff? (mark one in each column)

	In Case of Hurricane	In Case of Tsunami
Very likely to evacuate	○	○
Somewhat likely to evacuate	○	○
Not at all likely to evacuate	○	○

If you decided to evacuate and seek safe shelter from an approaching hurricane or tsunami, where do you expect that your residents and staff would go? (Please mark one in each column)

	In Case of Hurricane	In Case of Tsunami
Just move to higher ground; not a shelter	○	○
A higher floor in our facility	○	○
A public shelter or public school	○	○
A private school	○	○
A hotel/motel	○	○
A shelter on a military base	○	○
A house of a relative or friend	○	○
A church/religious building	○	○
A hospital	○	○
My workplace	○	○
Off island	○	○

14. T his is important: If a HURRICANE were approaching and you decided to evacuate, where would your residents and staff go? (please be as specific as possible: the name of a building, the closest cross streets, OR the neighborhood.)

Specifically:

15. And in the case of a TSUNAMI, where would your residents and staff go? (please be as specific as possible: the name of a building, the closest cross streets OR the neighborhood.)

Specifically:

16. What would be the TWO most important factors in helping you decide whether or not to evacuate your facilities?

_________________________________________

_________________________________________

17. How much lead time do you feel the Civil Defense authorities should give when recommending evacuation? ( mark one in each column)

	In Case of Hurricane	In Case of Tsunami
48 hours or more	○	○
24 to less than 48 hours	○	○
12 to less than 24 hours	○	○
6 to less than 12 hours	○	○
3 to less than 6 hours	○	○
1 to less than 3 hours	○	○
Up to 1 hour	○	○

18. Once your decision is made to evacuate, how much time do you need to close and evacuate your facilities? (Mark one in each column)

	In Case of Hurricane	In Case of Tsunami
48 hours or more	○	○
24 to less than 48 hours	○	○
12 to less than 24 hours	○	○
6 to less than 12 hours	○	○
3 to less than 6 hours	○	○
1 to less than 3 hours	○	○
Up to 1 hour	○	○

19. How long do you expect it will take to get from your facility to your shelter location? (record your estimates in minutes; please enter 99 if you don’t know)

	In Case of Hurricane	In Case of Tsunami
Number of minutes

And how would your residents and staff get there? (mark all that apply)

	In Case of Hurricane	In Case of Tsunami
Facility vans and buses	○	○
Hired vans and buses	○	○
Personal cars	○	○
Handivan	○	○
Other government vehicles	○	○
Taxis	○	○
Walk	○	○
Other (specify: _________________)	○	○

21. If you went by vehicle, how many vehicles would it take to move your residents and staff to a safe shelter? (please write in the number in the box to the right)

22. Understanding that occupancy may fluctuate, approximately how many residents and staff are present in your facilities on an average day? (please fill in the approximate number of people in each category)

Number of residents
Number of staff
Number of staff that would stay in case of an emergency

23. Approximately what percent of your residents require special medical care and what percentage of your residents require special assistance when being transported?

Percent of residents with special medical care needs	_____ %
Percent of residents who require special assistance when being transported	_____ %

24. In general, how much confidence do you have in the ability of our civil defense agencies to decide whether you really need to evacuate?

A great deal of confidence ○

Some confidence ○

Little or no confidence ○

25. In general, do the civil defense officials on your island give you too much, just enough or too little information about approaching hurricanes?

Too much information ○

Just enough information ○

Too little information ○

26. Does your establishment have an emergency response manual already prepared for dealing with the threat of hurricanes or tsunamis?

Yes, we have a prepared manual ○

No, but we are in the process of preparing one ○

No, we do not have one nor are we preparing one ○

27. H ow often does your staff check the emergency kits and practice emergency response procedures?

Every six months ○

Annually ○

Every other year ○

Less than every other year ○

HURRICANE EXPERIENCE

28. Has this establishment experienced any hurricanes? (mark all that apply)

Yes, we went through Hurricane ________ ○

Yes, we went through Hurricane ______ ○

Yes, we have been through other hurricanes ○

We have not experienced a hurricane ○

IF YOUR FACILITY HAS NOT EXPERIENCED A HURRICANE, GO TO QUESTION 33

29. Thinking of your last hurricane experience, did management evacuate the facility?

Yes ○

No ○

I don’t remember ○

30. If evacuation occurred, where did you and your residents go?

We did not evacuate ○

We went to a public shelter or public school ○

We went to a private school ○

We went to a hotel/motel ○

We went to a church or other religious building ○

We dispersed to multiple locations ○

Other location (specify: ________________________) ○

I don’t know ○

31. Has your facility experienced any of the following from ANY hurricane? (please mark all that apply)

	Main Structure	Other Structures	Vehicles	FF&E
Minor Damage	○	○	○	○
Major Damage	○	○	○	○
Destroyed	○	○	○	○
Don’t know	○	○	○	○

TSUNAMI EXPERIENCE

32. Has your facility experienced a tsunami?

Yes ○

No, we have not experienced a tsunami ○

IF YOUR FACILITY HAS NOT EXPERIENCE A TSUNAMI, PLEASE GO TO QUESTION 37

33. Thinking of your last tsunami experience, were your facilities evacuated?

Yes ○

No ○

I don’t know ○

34. If the facilities were evacuated, where did you and your residents go?

We did not evacuate ○

We did not leave, we moved to a higher floor in our

facility ○

We left, but just moved to higher ground ○

We went to a public shelter or public school ○

We went to a private school ○

We went to a church or other religious building ○

We dispersed to multiple locations ○

Other location (specify: ________________________) ○

35. Has your facility experienced any of the following from ANY tsunami? (mark all that apply)

	Main Structure	Other Structures	Vehicles
Minor Damage	○	○	○
Major Damage	○	○	○
Destroyed	○	○	○
Don’t Know	○	○	○

FACILITY INFORMATION

36. How likely are each of the following to cause damage to your facility ( mark one in each column)

	Flooding/ Flash Flood	Ocean Waves	High Winds	Landslides	Brush Fires
Very Likely	○	○	○	○	○
Possibly	○	○	○	○	○
Very Unlikely	○	○	○	○	○
Not Sure	○	○	○	○	○

37. How many residential rooms are there in your facility?

1 to 5 rooms ○

6 to 10 rooms ○

11 to 50 rooms ○

51 or more rooms ○

38. How many buildings are in your facility?

1 building ○

2 to 5 buildings ○

6 or more buildings ○

39. How tall is your main residential building?

It’s a ONE story building ○

It’s a TWO story building ○

The building has THREE to SIX stories ○

The building has SEVEN or more stories ○

40. I s your building mostly made of ________ .? (please mark one)

Wood, single wall construction ○

Wood, double wall construction ○

Concrete block or poured in place concrete ○

Brick ○

Metal ○

Other material (specify: ________________________) ○

I’m not sure ○

41. Approximately what year were the core buildings built (enter 9999 if you don’t know)?

42. How worried are you that there will be a HURRICANE or a TSUNAMI in next year that will cause major damage on your island?

Very worried ○

Somewhat worried ○

Not at all worried ○

43. Finally, if you could pass on a message or suggestion to Civil Defense in order to make their preparation for hurricanes and tsunamis more effective, what would it be?

Suggestion:

________________________________________________

________________________________________________

:________________________________________________

Thank you very, very much for completing in this survey; please mail it back as quickly as possible in the enclosed self-addressed envelope. Your participation is critical to good emergency planning in ________________.

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