The __________________________Family Disaster Plan
Last Updated: ___________________________________
Names of People in this Family:
______________________________________ _____________________________________
______________________________________ _____________________________________
______________________________________ _____________________________________
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 flood, hazardous materials spill or other neighborhood evacuation,
Our meeting place outside of our neighborhood 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 that person, the back up contact is:
Name__________________________________________ Phone: ________________________________________________
Emergency Telephone Numbers:
For All Emergencies: 9-1-1
Office of Emergency Services: ____________________________________________________________________________
Poison Control Center: __________________________________________________________________________________
Fire Department: _______________________________________________________________________________________
Police or Sheriff: _______________________________________________________________________________________
Hospital: ______________________________________________________________________________________________
American Red Cross Chapter: ____________________________________________________________________________
Salvation Army: ________________________________________________________________________________________
VA State Police: ________________________________________________________________________________________
Health Department: _____________________________________________________________________________________
National Response Center (Chemical, Oil Spills, Chemical/Biological Terrorism): 800-424-8802
Power Emergency Number: ______________________________________________________________________________
Acct. # ________________________________________________________________________________________________
Telephone: ____________________________________________________________________________________________
Cellular Phones: _______________________________________________________________________________________
TV Cable: _____________________________________________________________________________________________
Heating Fuel: __________________________________________________________________________________________
Propane: ______________________________________________________________________________________________
Acct. # ________________________________________________________________________________________________
Pump Septic Tank: _____________________________________________________________________________________
Water Pump Service: ____________________________________________________________________________________
Other Important Numbers:
Our Neighbors' Telephone Numbers:
Name: ________________________________________________________________________________________________
Address: ______________________________________________________________________________________________
Phone #: ______________________________________________________________________________________________
Cell Phone #:___________________________________________________________________________________________
Name: ________________________________________________________________________________________________
Address: ______________________________________________________________________________________________
Phone #: ______________________________________________________________________________________________
Cell Phone #:___________________________________________________________________________________________
Name: ________________________________________________________________________________________________
Address: ______________________________________________________________________________________________
Phone #: ______________________________________________________________________________________________
Cell Phone #:___________________________________________________________________________________________
Name: ________________________________________________________________________________________________
Address: ______________________________________________________________________________________________
Phone #: ______________________________________________________________________________________________
Cell Phone #:___________________________________________________________________________________________
Our Insurance Policies:
Health Insurance Information
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Social Security #: ________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Dental/Optical Insurance Information
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Flood Insurance
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Life Insurance Information
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
House Insurance Information
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Business Insurance
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Vehicle Insurance Information
Company Name: ________________________________________________________________________________________
Group Name or #: _______________________________________________________________________________________
Subscriber: ____________________________________________________________________________________________
Telephone #: ___________________________________________________________________________________________
Other Information: _______________________________________________________________________________________
Our Family Medical Information:
Medical Information (Name): _____________________________________________________________________________
Doctor's Name & Phone Number: ___________________________________________________________________________
Dentist's Name & Phone Number: ___________________________________________________________________________
Pharmacy Name & Phone Number: _________________________________________________________________________
Prescriptions:
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
Medical Information (Name): _____________________________________________________________________________
Doctor's Name & Phone Number: ___________________________________________________________________________
Dentist's Name & Phone Number: ___________________________________________________________________________
Pharmacy Name & Phone Number: _________________________________________________________________________
Prescriptions:
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
Medical Information (Name): _____________________________________________________________________________
Doctor's Name & Phone Number: ___________________________________________________________________________
Dentist's Name & Phone Number: ___________________________________________________________________________
Pharmacy Name & Phone Number: _________________________________________________________________________
Prescriptions:
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
RX #: _________________________________________________________________________________________________
Drug Name & Dose: _____________________________________________________________________________________
Doctor: ________________________________________________________________________________________________
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.