Dane County Emergency Management
-440690-207645007385685-11430000Household Emergency PlanGenesee County Health DepartmentHousehold Name:Address:Phone:Cell:Date Plan was established : Date Plan was updated:Date Plan was updated:-520065183515 HYPERLINK "" gchd.us HYPERLINK "" gchd.us Member Information Last Updated:________________NameDate of BirthSocial Security #Home & Cell #Work / School #Work / School AddressOther Contact #Last Updated:________________Pet Name / Species / Description / License # / Microchip #AgeVeterinarianVet Contact InfoVet AddressUtilities / Insurance InfoLast Updated:________________Provider Emergency Contact #Account Info Water/SewerElectricGasTelephoneCable / InternetHome / Renters Insurance (agency & agent)Auto Insurance(agency & agent)Boat / Other Insurance(agency & agent)Emergency Contacts (Relatives / Friends / Neighbors) Last Updated:NameRelationshipAddressHome / Work / Cell #sEmailOut of Town Contact Out of Town Contact Notes:Household Medical InformationLast updated:Name / Age: Name / Age: Name / Age: Primary Care Doctor (Name)Contact #HospitalMedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #Name / Age: Name / Age: Name / Age: Primary Care Doctor (Name)Contact #HospitalMedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #MedicationInclude: Dosage / When Taken, Reason for Taking and Pharmacy Contact #POINT OF DISPENSING (POD)During a public health emergency the Genesee County Health Department may open Points of Dispensing (POD). A POD is a place where you can get medicine or vaccines that will help keep you from getting sick during a public health emergency.If the POD is dispensing medicine that can be taken at home, the head of your household will come to the POD to pick up medication for everyone in the household. Bring the following information for you and anyone else you’re picking up medicine for:List of medicines being takenList of allergies to medicinesList of health conditionsList of the ages and approximate weights of any childrenFamily Member Information Last NameFirst NameMIBirth DateApproximateWeightSpecial Planning (allergies, medical conditions, pregnancy, etc.)1.2.3.4.5.Household emergency Procedures:Last Updated:Have a home emergency plan. Discuss where to meet and how to find each other if an emergency happens while household members are away from the home. Make plans for where household members should go and whom they should contact when they can’t go home. Learn and share emergency procedures for work, school, or other places where family members regularly spend time. Home Emergency Procedures:Home Emergency Plan Practiced on:Home Emergency Plan Practiced on:Workplace Emergency Procedures:School Emergency Procedures:Emergency Procedures for places where our family members / friends live (apartment buildings, assisted living facilities, etc.):Emergency Procedures for other places we visit often:If we cannot go home:Emergency procedures for our pets:If we are not together:Other emergency procedures (neighbors to check on, people to call, etc.):Home Layout / Diagram Last Updated: Draw a diagram of your home. Make sure you include:Locations of utility shutoffs (electric & gas) How to get out of the houseLocation of, smoke detectors, fire extinguishers, disaster supplies, etc.)Household emergency meeting / reunification pointsHOME SAFETYFind safe spots in your home where you can go for each type of emergency.Discuss what to do in an evacuation.Plan two unobstructed exits from every room, including the second floor and make sure everyone knows them.Pick two meeting places when evacuating:Outside of your home in case of a sudden emergency, like a fireOutside of your neighborhood in case you cannot return home:Use this checklist to help maintain an Emergency Preparedness Kit.Items in My Emergency Preparedness KitDate updatedWaterFoodFirst Aid SuppliesMedications Clothing & BeddingTools & Emergency SuppliesSpecial ItemsFirst Aid KitPet SuppliesEmergency Car KitGeneral Emergency Preparedness InformationEmergency Supplies (From FEMA):There are six basics you should stock for your home in the case of an emergency: WaterFoodFirst Aid SuppliesClothing & BeddingTools & Emergency SuppliesSpecial Items Keep the items that you would most likely need during an evacuation in an easy-to carry container. Water, one gallon of water per person per day, for drinking and sanitationFood, at least a three-day supply of non-perishable foodHand can opener for food (if kit contains canned food) Battery-powered radio and a NOAA Weather Radio with tone alert, and extra batteries for bothFlashlight and extra batteriesFirst Aid kit (be sure to note the expiration date)Whistle to signal for helpInfant formula and diapers, if you have an infantMoist towelettes, garbage bags and plastic ties for personal sanitationDust mask or cotton t-shirt, to help filter the airPlastic sheeting and duct tape to shelter-in-placeWrench or pliers to turn off utilitiesClothing and Bedding:(If you live in a cold weather climate, you must think about warmth. It is possible that the power will be out and you will not have heat. Rethink your clothing and bedding supplies to account for growing children and other family changes.) One complete change of warm clothing and shoes per person, including:- A jacket or coat- Long pants- A long sleeve shirt- Sturdy shoes- A hat and gloves- A sleeping bag or warm blanket for each person Below are some other items for your family to consider adding to its supply kit. Some of these items, especially those marked with a * can be dangerous, so keep them away from children.Emergency reference materials such as a first aid book or a print out of the informationRain gearMess kits, paper cups, plates and plastic utensilsCash or traveler's checks, changePaper towelsFire ExtinguisherTentCompassMatches in a waterproof container*Signal flare*Paper, pencilPersonal hygiene items including feminine suppliesHousehold unscented chlorine bleach* - You can use bleach as a disinfectant (diluted nine parts water to one part bleach), or in an emergency you can also use it to treat water. Use 16 drops of regular household liquid bleach per gallon of water. Do not use scented, color safe or bleaches with added cleaners.Medicine dropperImportant Family Documents such as copies of insurance policies, identification and bank account records in a waterproof, portable containerCover Your Cough - Serious respiratory illness like influenza, respiratory syncytial virus (RSV), whooping cough, and sever acute respiratory syndrome (SARS) are spread by coughing or sneezing and unclean hands.To help stop the spread of germs:Covery your mouth and nose with a tissue when you cough of sneezeIf you don’t have a tissue, cough or sneeze into your upper sleeve, not your handsPut your used tissue in the waste basketClean your hands after coughing or sneezing !Wash with soap and water or Clean with alcohol-based and cleanerNote: You may consider wearing a surgical mask to protect others.center2095500HANDWASHINGWhen should you wash your hands?Before, during, and after preparing foodBefore eating foodBefore and after caring for someone who is sickBefore and after treating a cut or woundAfter using the toiletAfter changing diapers or cleaning up a child who has used the toiletAfter blowing your nose, coughing, or sneezingAfter touching an animal, animal feed, or animal wasteAfter handling pet food or pet treatsAfter touching garbageHow should you wash your hands?Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.Rinse your hands well under clean, running water.Dry your hands using a clean towel or air dry them.What should you do if you don’t have soap and clean, running water?Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs. Hand sanitizers are not as effective when hands are visibly dirty or greasy. How do you use hand sanitizers?Apply the product to the palm of one hand (read the label to learn the correct amount).Rub your hands together.Rub the product over all surfaces of your hands and fingers until your hands are dry. General Emergency Situation InformationWeatherKnow the types of hazards, both natural and man-made, that are most common in your area. Michigan experiences severe weather year round, including tornadoes, thunderstorms, high winds, flooding, snowstorms, and ice storms. Because of this, you should understand the difference between a watch and a warning for severe weather.Severe Weather Watch: A severe weather watch means that severe weather may develop.Severe Weather Warning: A severe weather warning means a storm has developed and is on its way.The safest place to ride out any storm is inside a secure building, home, or apartment building. You should:Listen to weather updates and stay informed.Stay away from windows and doors.Keep your emergency supply kit handy, including a battery operated NOAA weather radio.Be ready to evacuate if necessary.FloodingShelter – In – Place: (from the American Red Cross)Shelter-in-place means selecting a small, interior room, with no or few windows, and taking refuge there. It does not mean sealing off your entire home or office building. Contaminants may be released accidentally or intentionally into the environment. Should this occur, information will be provided by local authorities via television and radio stations or by a phone call on how to protect you and your family. Because information will most likely be provided on television and radio, it is important to keep a TV or radio on. The important thing is for you to follow instructions of local authorities and know what to do if they advise you to shelter-in-place. If you are told to shelter-in-place, follow these instructions:Close and lock all windows and exterior doors. If you are told there is danger of explosion, close the window shades, blinds, or curtains. Turn off all fans, heating and air conditioning systems. Close the fireplace damper. Get your household disaster supply kit and make sure the radio is working. Go to an interior room without windows that's above ground level. In the case of a chemical threat, an above-ground location is preferable because some chemicals are heavier than air, and may seep into basements even if the windows are closed. Bring your pets with you, and be sure to bring additional food and water supplies for them. It is a good idea to have a hard-wired telephone in the room you select. Call your emergency contact and have the phone available if you need to report a life-threatening condition. Cellular telephone equipment may be overwhelmed or damaged during an emergency. If instructed to do so, use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the door and any vents into the room. Keep listening to your radio or television until you are told all is safe or you are told to evacuate. Local officials may call for evacuation in specific areas at greatest risk in your community. Remember that instructions to shelter-in-place are usually provided for durations of a few hours, not days or weeks. There is little danger that the room in which you are taking shelter will run out of oxygen and you will suffocate. If you are driving a vehicle and hear advice to “shelter-in-place” on the radio, take these steps: If you are very close to home, your office, or a public building, go there immediately and go inside. Follow the shelter-in-place recommendations for the place you pick described above. If you are unable to get to a home or building quickly and safely, then pull over to the side of the road. Stop your vehicle in the safest place possible. If it is sunny outside, it is preferable to stop under a bridge or in a shady spot, to avoid being overheated. Turn off the engine. Close windows and vents. If possible, seal the heating/air conditioning vents with duct tape. Listen to the radio regularly for updated advice and instructions. Stay where you are until you are told it is safe to get back on the road. Be aware that some roads may be closed or traffic detoured. Follow the directions of law enforcement officials.Local officials on the scene are the best source of information for your particular situation. Following their instructions during and after emergencies regarding sheltering, food, water, and clean up methods is your safest choice. Evacuation: (from FEMA)When community evacuations become necessary, local officials provide information to the public through the media. In some circumstances, other warning methods, such as sirens or telephone calls, also are used. Additionally, there may be circumstances under which you and your family feel threatened or endangered and you need to leave your home, school, or workplace to avoid these situations.The amount of time you have to leave will depend on the hazard. However, many emergencies allow no time for people to gather even the most basic necessities, which is why planning ahead is important!FEMA’s Evacuation Guidelines:Always:If time permits:Plan places where your family will meet, both within and outside of your immediate neighborhood. Keep a full tank of gas in your car if an evacuation seems likely. Gas stations may be closed during emergencies and unable to pump gas during power outages. Plan to take one car per family to reduce congestion and delay. Make transportation arrangements with family or friends or your local government if you do not own a car.Listen to a battery-powered radio and follow local evacuation instructions.Gather your family and go if you are instructed to evacuate immediately.Leave early enough to avoid being trapped by severe weather.Follow recommended evacuation routes. Do not take shortcuts; they may be blocked.Be alert for washed-out roads and bridges. Do not drive into flooded areas.Stay away from downed power lines.Take your pets with you, but understand that only service animals may be permitted in public shelters.Take your emergency supply kit with you. Call or email the out-of-state contact in your family communications plan. Tell them where you are going.Secure your home by closing and locking doors and windows.Unplug electrical equipment such as radios, televisions and small appliances. Leave freezers and refrigerators plugged in unless there is a risk of flooding. If there is damage to your home and you are instructed to do so, shut off water, gas and electricity before leaving.Leave a note telling others when you left and where you are going.Wear sturdy shoes and clothing that provides some protection such as long pants, long-sleeved shirts and a cap.Check with neighbors who may need a ride. ................
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