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1 Write down your family s contact information and the contact information for other important people/offices, such as medical facilities, doctors, schools and other service providers. Share your disaster plan with every member of your family. Make sure everyone carries a copy in his or her backpack, purse or wallet. Print your family disaster plan and place it where the entire family can access it. Have regular household meetings to review and practice your plan. Follow us on Social CVIFD

2 The Chino Valley Fire District takes pride in empowering residents with information to help them plan, prepare and practice for any natural or manmade disaster that they may face. The Chino Valley is located within an area of Southern California where a major earthquake is projected to occur. A large-scale earthquake has the potential to impact families and overwhelm emergency responders. It is important for families within the Chino Valley to be prepared and self-sufficient for a minimum of seven to 10 days. The Chino Valley Fire District created this template as a guide to help you through the process of creating your Family Emergency Communication plan. This document is a plan template and is intended to give you a format and suggestions about information you may want to include in a family disaster plan. It is not all inclusive and should be modified by the user to suit individual or family needs. Keep this plan updated with current and correct information. Update and Plan Review: Date:

3 Household Members Name: Cell Phone: Physician Name/Phone #: Dentist: Name/Phone #: Pets Name: Rabies Vaccine Date/Number: Veterinarian Name/Phone #:

4 Household Information Home Insurance Company: Agent: Policy Number: Phone Number: Vehicle Information Vehicle #1: Make: Model: Year: License # Vehicle #2: Make: Model: Year: License # Vehicle #3: Make: Model: Year: License # Vehicle #4: Make: Model: Year: License # Vehicle Insurance Company Agent: Policy Number: Phone Number:

5 Emergency Numbers Fire Department: Chino Valley Fire District Phone: Police Department: Phone: Hospital: Phone Number: Poison Control: Out of State Emergency Contact Other Emergency Contacts

6 Other Insurance Information Family Disaster Plan Insurance Policy Type: Insurance Company Name: Agent: Phone Number: Policy Number: Insurance Policy Type: Insurance Company Name: Agent: Phone Number: Policy Number: Insurance Policy Type: Insurance Company Name: Agent: Phone Number: Policy Number:

7 Utility and Service Contracts Family Disaster Plan Electric Company: Phone Number: Account Number: Mailing Address: Gas Company: Phone Number: Account Number: Mailing Address: Water Company: Phone Number: Account Number: Mailing Address: Phone Company: Phone Number: Account Number: Cell Phone Company: Phone Number: Account Number:

8 Additional Contacts Family Disaster Plan Neighbors: Identify two (2) Neighbors. Agree to check on each other Name Phone Number: Name Phone Number: Employment/School Contacts Household Member: Place of Employment/School: Address: Phone Number: Household Member: Place of Employment/School: Address: Phone Number: Household Member: Place of Employment/School: Address: Phone Number:

9 Reunion Procedures Identify and discuss with household members a reunion place if a disaster prevents anyone from entering the home. Reunion and evacuation procedures need to include children at school and household members with disabilities. Talk to school officials. Write down procedures. Meeting Place: When Family is NOT home, priority location: (Leave a note in a designated place that states where you will be. Leave a note with a neighbor, relative, or at a school, shelter, etc.) Important Notes and Procedures:

10 Medications and Pharmacy Household Member: Allergies: Physician/Pharmacy: Phone Number: Medications and Pharmacy Household Member: Allergies: Physician/Pharmacy: Phone Number: Medications and Pharmacy Household Member: Allergies: Physician/Pharmacy: Phone Number:

11 Home Layout/Diagram Draw a layout of your home. Include utility shutoffs and safety equipment like fire extinguishers, disaster supplies, etc.