Special Request

Effort is under way to develop and implement a Disaster Recovery plan for all of Boca Chase. The master plan calls for each sub-association/community to have its own cell of first responders, with provisions for each community to have direct radio communications with a central control point for reporting and mutual assistance. To that end, we are requesting all residents to please respond to the brief survey below, and provide the information requested.

(Please note: all information provided here will be treated with the utmost of privacy. This information will be used strictly as a pool of
information when it becomes necessary to respond in event of a community disaster.).

 

Emergency Preparedness Questionnaire


*  Family Surname
  
*  Street Address
* Name of your Development
* Home Phone Number
* Cell Phone Number
* email address

*  Required Field

Please list names and ages of people in your household:

 

Any family members with special needs (i.e. refrigerated meds, electric wheel chair, etc.)?

Yes       No

If "yes", please explain

 

Please list any special skills in your household (i.e. Medical training/profession, fire rescue, EMT, law enforcement
emergency management, communications, construction/carpenter, computer skills, other):

 

Please list any special tools and/or equipment at your disposal (i.e. 4-wheel drive vehicle, Bucket truck, chain saw,
emergency generator, power equipment, excess refrigerator/freezer capacity (with auxiliary power):

 

May we add you to our list of volunteers if and when needed for emergency response within Boca Chase?

Yes       No


Please feel free to include any thoughts or comments not solicited in the questions above:


Thank you for your participation in this questionnaire. For any additional correspondence or discussion on this topic, please email Mike Pilgrim
(mpilgrim@bellsouth.net)


Be sure you have completed all the required fields (above) before pressing the "submit button".