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Family Emergency Plan and Go Bag Checklist

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Steps

1. Household Information(current) This section is complete This section is incomplete
2. Emergency Contacts This section is complete This section is incomplete
3. Emergency Meeting Places This section is complete This section is incomplete
4. Medical Information This section is complete This section is incomplete
5. Go-Bag Checklist This section is complete This section is incomplete

Household Information

Household Emergency Plan
Use this form as a template for creating your household emergency plan. Feel free to add to it as needed.
Household Information:
Household Phone Number
Household Address
City
State
Zip Code
Family Members:
Name
Cellular Phone Number
Email
Important Medical or Other Information
Name
Cellular Phone Number
Email
Important Medical or Other Information
Name
Cellular Phone Number
Email
Important Medical or Other Information
Name
Cellular Phone Number
Email
Important Medical or other Information
Continue

Emergency Contacts

Emergency Contacts:
Name
Cellular Phone Number
Home Phone Number
Email
Address
City
State
Zip Code
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Emergency Meeting Places

Emergency Meeting Place
Address
City
State
Zip Code
Special Instructions
Include any instructions for your meeting place such as gate codes, transportation options, etc.
Continue |Go Back

Medical Information

Medical Information
Poison Control: 1-800-222-1222
Doctor Name
Doctor Phone Number
Pediatrician Name
Pediatrician Phone Number
Allergy Information and Prescriptions
Medical Insurance Name
Medical Insurance Policy Number
Veterinarian Name
Veterinarian Phone Number
Additional Information
Continue |Go Back

Go-Bag Checklist

Rohnert Park Department of Public Safety Go Bag Checklist
Basic Emergency Bag
1. Copy of Important Papers
2. Emergency Contact List
3. First Aid Kit
4. LED Flashlight
5. Whistle
6. Snacks -Granola Bars, Jerky, etc.
7. Disposable Face Masks & Gloves
8. Hand Sanitizer
9. Reusable Water Bottle
10. Mylar Blanket
11. Emergency Poncho
12. Travel Toothbrush
13. Garbage Bags
14. _________________________________
15. _________________________________
16. _________________________________
17. _________________________________
Suggested Items to Add
1. Spare Glasses/ Hearing Aids/ Batteries
2. All Necessary Chargers
3. Medications (for 7 days)
4. Personal Hygiene Items
5. Emergency Radio & Batteries
6. Layered Clothing (for 3 days)
7. Warm Jacket, Hat, Gloves, Socks
8. Old Sneakers or Walking Shoes
9. Warm Blanket or Sleeping Bag
10. Extra Snacks - Bars, Jerky, etc. (6)
11. Cash ($300, small bills)
12. Spare Keys, including Safety Deposit Box
13. Family Photo (or other momento)
14. _________________________________
15. _________________________________
16. _________________________________
17. _________________________________
Pet Emergency Bag
1. Carrier
2. Food (pop top) & Water (3 days), Bowls
3. Medications/Supplements
4. Waste Bags & Garbage Bags (10 each)
5. Kitty Litter Box and Litter
6. Towel/ Blanket/ Toys
7. Collar/ Leash/ Harness
8. Photo of Pet with Name
9. ________________________________
10. ________________________________
11. ________________________________
12. ________________________________
Personalize Your Emergency Bag
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
5. _________________________________
6. _________________________________
7. _________________________________
8. _________________________________
9. _________________________________
10. _________________________________
11. _________________________________
12. _________________________________

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130 Avram Avenue
Rohnert Park, CA 94928-1180

(707) 588-2226
Monday to Friday, 8 am to 5 pm

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