EMERGENCY PREPAREDNESS AND RESOURCES SURVEY

Address:     

City:                   State:     Zip Code:

Telephone:  
                      Home                                        Cell

E-mail:        

Are you Community Emergency Response Team (CERT) Trained?

yes   no

If yes, would you be willing to take on Area Coordinator or Team Leader duties?

yes   no

If no, would you like to be CERT Trained? (The training is a 21-hour course taught by the Unified Fire Authority personnel.)

yes   no

If yes, please check the training schedule you would be most interested in:

7 Weeknight evenings (list day of the week ).
2 days a week for 3 weeks, plus one Saturday practice drill.
Three all day Saturday sessions.

In a disaster-level emergency, professional help may be unavailable for extended periods of time. We would like to identify neighborhood resources that may be available in the event of an emergency.

Trade skills for emergency response:

Trade skills for utility emergencies:

Equipment resources garaged near Herriman:

Other resources:

We appreciate your response.