Form FEMA Form 008-0-8 FEMA Form 008-0-8 Community Drill Day Registration

OMB Control Number: 1660-NEW
Expiration Date: None

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data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is voluntary. You are not required to
respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency
Management Agency, 1800 South Bell Street, Arlington VA 20598-3005, Paperwork Reduction Project (1660-NEW). NOTE: DO NOT SEND YOUR COMPLETED FORM TO THIS
ADDRESS.
PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Act as amended, § 201, 42 U.S.C. § 5131; Reorganization Plan No. 3 of 1978; and Presidential
Policy Directive (PPD) – 8, National Preparedness, dated March 30, 2011.
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of registration of an individual or organization to access the Community Drill Day
website. Additionally, information may be used for contact purposes by FEMA and other registered users, and to assess the capabilities and readiness of the registrant for
disaster response.
ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using
this information as necessary and authorized by the routine uses published in DHS/ALL-004 - General Information Technology Access Account Records System (GITAARS)
System of Records, 74 Fed. Reg. 49882 (Sept. 29, 2009); and upon written request, by agreement, or as required by law.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may prevent registration to the site and receipt
of information from FEMA and other registered users of the site.
FEMA Form Number: 008-0-8

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Section I: Registering for Individual or Organization
I/We will participate in the Community Drill Day on October 17, 2013.
I am registering for:

(If under 18, ask a parent to register)

Yes

No

Please select one
Myself/Family
School/ College/University/Childcare Center
Organization/Department/Agency

If you selected “My school, college/university, or childcare center:” Review this list and select the
appropriate category of school. Choose an item.

Please select one
Childcare/pre-schools
K-12 schools/districts
Colleges/universities

How many schools or sites are you registering to participate?

1

How many staff including employees, volunteers, parents, etc. will participate?

65

Please select the number of students will participate?

15

The question below help us understand how these populations participate in drills
How many of your participants have disabilities of access/functional needs?

(Access/functional needs include mobility, hearing, sight, speech, cognitive, developmental, mental, etc.)

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Section I: Registering for Individual or Organization
Select the other groups you belong to: (Use Ctrl + Shift or Ctrl for multiple selections)
Access/Funtional/Disability Needs Organizations
Business/ Industry Associations
CERT Groups
Childcare and Preschool
Citizen Corps Council
Colleges/Universities
Communication Groups
Congressional
Media Organizations
What communication channels do you plan on using to connect with potential participants? (Please
check all that apply.)

Website
Email
Radio/TV
Newspaper
Flyer
Newsletter
Direct Mail
Social Media

Phone
Meeting/Event
Other (Please specify):
Not sure

What tools would you be interested in for promoting to potential participants? (Please check all that apply.)
Fact sheets or tip sheets
Media advisories
Posters/Flyers
Language to post on my website
Audio recordings
Language to post on my Facebook page or
other social media site
Videos
Articles for my newsletters
Web banners
A mobile application
Postcards
Other (Please specify):
Drill Manuals
The question below helps us understand how confident you are in your and your school’s
ability to respond to a disaster.
How confident are you in your and your school’s ability to know what to do ? Please use a scale of 1 to
5, with 5 being “very confident” and 1 being “not at all confident.”

1 In the first five minutes of a terrorist act such as an explosion of a

radiological or dirty bomb?
2 In the first five minutes of a hazardous materials accident such as
the release of a chemical agent?
3 In the first five minutes of a sudden natural disaster such as an
earthquake or tornado that occurs without warning?
4 In a highly contagious disease outbreak such as H1N1?
4 In a weather emergency such as a hurricane or major snowstorm?

5 In a wildfire?
5 In a flood?

Section II>>

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Section II: Contact Information
Organization Name: Pembroke Elementary School
Department:
What are you registering? Please select one

The participation of my organization
The participation of my department
Subset of my organization
Name (First and Last): Cameron Smith
What is your job title?

City: San Diego

State:

Zip Code:

Phone Number (optional):
Would you like to recieve a text alert at the time of the drill?

Yes

No

Email: [email protected]
Choose a password:

Your Password should be between 8 and 16 characters and will be case sensitive.

Repeat password:
Time Zone:
Section III>>

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Section III: Participation

What type of hazard will you drill on October 17, 2013? Please select one

Earthquake
Hazardous materials/Terrorism
Icestorm
What drill-related activities are you participating in? (Please check all that apply.)

x Drill/ Exercise

x Preparedness Discussion

Tabletop or simulation activity

Section IV>>

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Section IV: Permissions and Next Steps
By agreeing to add your Please select one

Myself/Family
School/College/University/Childcare Center
Organization/Department/Agency
on the Community Drill Day website, you will be listed among millions of participants from across the
country who are voluntarily taking part in a drill activity to build and sustain national preparedness and
enhance national resilience.
Would you agree to list your name/organization on our website as a participant?

Yes

No

How do you want to be listed? (i.e. American Red Cross of Alabama, American Red Cross, or Self)

Would you like to recieve messages from the Ready Campaign?

Yes

No

Can we send you e-mail updates about the Community Drill Day?

Yes

No

Can we contact you after Community Drill Day to learn about your experience?

Yes

No

Would you like to sign up to be a National Coalition Member?

Yes

No

If you click yes, you will be brought to a page at the end of this registration to finalize your coalition membership. Becoming a
coalition member will give you access to log in information and allow you to update your drill profile at any time for this event
and future events. The coalition also offers exclusive resources and discussion boards for members.

Do you allow the name of your organization to be used in materials about National Preparedness,
Including listed on the website or in other materials?
Yes
No

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Section V: Other Preparedness Activities
Have you participated in an Icestorm drill before?

Yes

No

Not Sure

What makes you want to participate in Community Drill Day? (Please check all that apply.)
I want to know what to do during an actual
emergency in my community
I experienced an emergency or learned about
disasters in other places, and it motivated me
to become better prepared

x A friend, family member, or trusted leader

encouraged me to take steps to become better
prepared
Other (please specify):

Don’t Know

My job or school encouraged me to take steps
to become better prepared

I affirm to one or more of the following:
Learn the emergency I am at risk of and their appropiate responses
Create an emergency supply kit (or update existing kit)
Create an emergency plan (or update existing plan)
Volunteer, attend preparedness training or host a preparedness event in my community
I am going to help others prepare by coordinating:
A drill
Assembling kits
Creating plans
Understanding risks
Training sessions
An awareness campaign
I’m not sure yet
Other (please specify):
In addition to your drill, have you participated or do you plan on participating in any of these activities
over the next 6 months? (Please check all that apply.)
Participated Activities

Will Participate Over the Next 6 Months?

Created or updated emergency plans

Creating or updating emergency plans

Created or updated disaster supplies kits

Creating or updating disaster supplies kits

Participated in first aid classes or community
response team trainings

Participating in first aid classes or community
response team trainings

Took mitigation measures to secure home or building
to pprevent damage or injury

Will take mitigation measures to secure home or
building to prevent damage and injury

Practiced evacuating home or buildings

Practicing evacuating buildings

Tested communications plans

Testing communications plans

Simulated emergency response procedures

Simulating emergency response procedures

Conducted a tabletop exercise

Developing a Continuity of Operations Plan

Developed a Continuity of Operations Plan

Planning for data storage and/or internet security

Planned for data storage and/or internet security

Conducting a tabletop exercise

Other (Please specify):

Other (Please specify):

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Section V: Other Preparedness Activities
How did you learn about Community Drill Day? (Please check all that apply.)
A social media group, forum, or discussion
board

A colleague at work

A leader from my faith-based organization

From a local government spokesperson

A leader from an organization within my
community

An administrator at my or my child’s school
From a national government spokesperson

Through conversations with neighbors, friends,
or family (online or offline)

Other (Please specify):

Where did you hear about Community Drill Day? (Please check all that apply.)
On national TV

Through conversations with neighbors, friends, or family
(online or offline)

On local TV

At work, if appropriate

On the Internet

From your child’s school, if appropriate

Through e-mail

From your school, if appropriate

On the radio

From FEMA

In the newspaper
On social media

From a local government entity or spokesperson

At church or from a faith-based
organization

Not Sure

On the Ready.gov website

From a community organization

Other (Please specify):

Have you signed up for your community’s alerts and warning systems?
Yes

No

Not sure

In your community are you aware of any other groups participating in the drill? (Please check all that

apply.)

My Child/Children’s’ School
Local College/University
My Faith-based organization
Local community organization(s) I am a member
My Workplace
Local Business
Other (Please specify):

Click here for more resources related to preparedness drills.
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