Family
Emergency
Plan
Evacuation Plan
Neighborhood Meeting Place: ______________________________________________ Phone: _______________________________________________________________________
Out of Neighborhood Meeting Place: _______________________________________ Phone: _______________________________________________________________________
Communication Plan
• Fill in the information below. Add other important information to suit your family’s circumstances.
• Keep this plan with your emergency supplies kit.
• File a copy of emergency contact information.
• Make sure every family member has the most important contact information on a current Emergency Contact Card.
Where the family spends time
Home: School:
Address: ______________________________________________________________________ Address: _____________________________________________________________________
Phone: ________________________________________________________________________ Phone: _______________________________________________________________________
Evacuation Location: ________________________________________________________ Evacuation Location: _______________________________________________________
__________________’s Work: School:
Address: ______________________________________________________________________ Address: _____________________________________________________________________
Phone: ________________________________________________________________________ Phone: _______________________________________________________________________
Evacuation Location: ________________________________________________________ Evacuation Location: _______________________________________________________
__________________’s Work: Other place you frequent:
Address: ______________________________________________________________________ Address: _____________________________________________________________________
Phone: ________________________________________________________________________ Phone: _______________________________________________________________________
Evacuation Location: ________________________________________________________ Evacuation Location: _______________________________________________________
Contact information
Out-of-Town Contact: ________________________________________________________ Phone: _______________________________________________________________________
E-Mail: ________________________________________________________________________ Alternate Phone Number: __________________________________________________
PMO Phone: __________________________________________________________________ ______________________________________________________________
______________________________________________________________ __________________________________________________
Family members
Name: _________________________________________________________________________ ______________ Social Security #: _______________________________
___________________________________________________________ Passport #: ____________________________________________________________________
Prescriptions/Medical Information: ___________________________________________________________________________________________________________________________
Name: _________________________________________________________________________ ______________ Social Security #: _______________________________
___________________________________________________________ Passport #: ____________________________________________________________________
Prescriptions/Medical Information: ___________________________________________________________________________________________________________________________
Name: _________________________________________________________________________ ______________ Social Security #: _______________________________
___________________________________________________________ Passport #: ____________________________________________________________________
Prescriptions/Medical Information: ___________________________________________________________________________________________________________________________
Name: _________________________________________________________________________ ______________ Social Security #: _______________________________
___________________________________________________________ Passport #: ____________________________________________________________________
Prescriptions/Medical Information: ___________________________________________________________________________________________________________________________
DIAL 911 FOR EMERGENCIES
Set your own course through any hazard: stay informed, make a plan, build a kit. Live 2 Weeks Ready.
Your family may not be together when disaster strikes, so plan what you
will do in different situations and plan how you will contact one another.
Preparedness allows you to navigate life’s challenges.
’s
www.cityofmedford.org
Important contacts and insurance policy numbers
Name Phone Policy#
____________________________________________________________________ ___________________________ ___________________________________________________
____________________________________________________________________ ___________________________ ___________________________________________________
_______________________________________________________________________ ___________________________ ___________________________________________________
Pharmacy: ____________________________________________________________________ ___________________________ ___________________________________________________
Veterinarian/Kennel: ________________________________________________________ ___________________________ ___________________________________________________
Medical Insurance: __________________________________________________________ ___________________________ ___________________________________________________
____________________________________________________________ ___________________________ ___________________________________________________
Homeowners/Renters Insurance: _________________________________________ ___________________________ ___________________________________________________
Automobile Insurance: ______________________________________________________ ___________________________ ___________________________________________________
Life Insurance: _______________________________________________________________ ___________________________ ___________________________________________________
Provisions for Utilities
In various emergency situations, whether you shelter-in-place or evacuate, you may be advised to cut off ventilation systems or utilities.
Write the locations of, and instructions for, these controls and any tools necessary to change them.
Electricity:
________________________________________________________________________________________________________________________________________________________
Gas: _______________________________________________________________________________________________________________________________________________________________
Water: ____________________________________________________________________________________________________________________________________________________________
Ventilation: _______________________________________________________________________________________________________________________________________________________
Important Records
Use these checklists to help collect important papers to keep with your emergency supply kit for ready access in case of evacuation. If not
Personal Financial
Bank/credit union statements
Credit/debit card statements
Income records
Social Security cards Mortgage statement or lease
Passports Bills
Citizenship papers Health insurance cards and records
Marriage licenses, divorce records Other insurance records
Vehicle registration/ownership records Tax returns, property tax statements
Medical records Investment/retirement account records
Immunization records
Wills
Household goods inventory from last three PCS moves
Other important information
_____________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________
Set your own course through any hazard: stay informed, make a plan, build a kit. Live 2 Weeks Ready.
www.cityofmedford.org
Family Emergency Plan
Family members - continued
Name: _________________________________________________________________________ ______________ Social Security #:
_______________________________ ___________________________________________________________ Passport #:
____________________________________________________________________ Prescriptions/Medical Information:
___________________________________________________________________________________________________________________________ Name:
_________________________________________________________________________ ______________ Social Security #: _______________________________
___________________________________________________________ Passport #:
____________________________________________________________________ Prescriptions/Medical Information:
___________________________________________________________________________________________________________________________
Additional Important Phone Numbers & Information:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Family Emergency Plan
Emergency Contact Name:
Telephone:
Out-Of-Town Contact Name:
Telephone:
Neighborhood Meeting Place:
Telephone:
Out of Neighborhood Meeting Place:
Telephone:
DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER
< FOLD HERE >
Additional Important Phone Numbers & Information:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Family Emergency Plan
Emergency Contact Name:
Telephone:
Out-Of-Town Contact Name:
Telephone:
Neighborhood Meeting Place:
Telephone:
Out of Neighborhood Meeting Place:
Telephone:
DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER
< FOLD HERE >
Additional Important Phone Numbers & Information:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Family Emergency Plan
Emergency Contact Name:
Telephone:
Out-Of-Town Contact Name:
Telephone:
Neighborhood Meeting Place:
Telephone:
Out of Neighborhood Meeting Place:
Telephone:
DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER
Additional Important Phone Numbers & Information:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Family Emergency Plan
Emergency Contact Name:
Telephone:
Out-Of-Town Contact Name:
Telephone:
Neighborhood Meeting Place:
Telephone:
Out of Neighborhood Meeting Place:
Telephone:
DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER
www.cityofmedford.org
Family Emergency Plan
Fill out these cards and give one to each member of your family to make sure they know
who to call and where to meet in case of an emergency. Use this card for any
additional information needed to supplement primary and alternate points of contact.
