(Please check the box representing your answer)
1) How worried are you that a major hurricane (Cat 2 or Higher) will hit our community during the next 3 months?
a) Which is more severe a Cat 1 or Cat 5 hurricane on the saffir/simpson scale?
2) Overall, how prepared are you if a major hurricane (Cat 2 or higher) were to strike our community during the next 3 months?
Very Somewhat Not Too Not at all Don't Know
3) Compared to last year, are you more prepared for a major hurricane this year, less prepared, or is your preparation about the same?
More Prepared Less Prepared Preparation about the same Don't Know
4) Below is a list of things some people have in their homes that could be used in case of an emergency. For each one, please indicate below if that is something you currently have or do not have.
a.) Enough food for three days for each member of your family Yes No Don't Know
b.) Enough water for three days for each member of your family Yes No Don't Know
c.) A battery operated radio that you know works Yes No Don't Know
d.) A flashlight that you know works Yes No Don't Know
e.) A first aid kit Yes No Don't Know
f.) Extra batteries Yes No Don't Know
g.) A cell phone Yes No Don't Know
h.) At least $300 in cash to take with you if you had to leave your home Yes No Don't Know
i.) Sterno for heating food Yes No Don't Know
5) Do you or does anyone else in your household take prescription drugs on a regular or ongoing basis, or not?
Yes, on a regular basis No, not on a regular or ongoing basis Don't Know
6) In the event of a major hurricane (Cat 2 or higher), do you and other household members have at least an extra three week supply of the prescription drugs you take regularly, or not?
Yes No Don't Know
7) Are you, yourself now covered by any form of health insurance or health plan, or do you not have health insurance at this time?
Yes, covered No, not covered Don't Know
8) Do you have homeowner's or renter's insurance or don't you have this insurance at this time?
Yes, have homeowner's or renter's insurance No, don't have at this time Don't Know
9) Do you have flood insurance or don’t you have this insurance at this time?
Yes, have flood insurance No, don't have at this time Don't Know
10) Do you have or don’t you have a social security number?
Yes, have SS# No, don't have SS# Don't Know
11) If government officials said that you had to evacuate the area because there was going to be a major hurricane (Cat 2 or higher) in the next few days, would you leave the area or would you stay?
Yes, would leave No, would stay Not sure what I would do
12) If you had to evacuate the area where you live because of a major hurricane (Cat 2 or higher), where would you go? Would you…?
Stay with friends/family members in another area Go to a hotel/ motel Go to an evacuation center run by the Red Cross/ government Sleep in a car or outdoors Don't Know where youu would go
13)Do you know the location of the evacuation center where you would go?
a) Are you familiar with the evacuation routes for from the island (Ocean City, NJ) ?
b) Are you familiar with the evacuation routes for Cape May County?
14) If you had to evacuate because of a major hurricane (Cat 2 or higher), how far away would you go?
Less than 10 miles 10-50 miles 50-100 miles 100-200 miles More than 200 miles Don't Know
15) If you had to evacuate, how would you get to where you are going? Would you…?
Go in your car In a friend's car Use public transportation Walk or ride a bike Don't Know how you would evacuate
16) Below is a list of documents that people sometimes take with them when they evacuate. For each one, please indicate if you would be able to take this document with you if you only had 6 hours until you had to leave?
a.) Proof of healtth insurance Yes would be able to take with me No, would not be able to take with me Don't Know
b.) Proof of prescriptions for the drugs you and your family are taking Yes would be able to take with me No, would not be able to take with me Don't Know
c.) Proof of homeowner’s or renter’s insurance Yes, would be able to take with me No, would not be able to take with me Don't Know
d.) Your social security card Yes would be able to take with me No, would not be able to take with me Don't Know
17) If you had to evacuate because of a major hurricane (Cat 2 or higher), when would you return home? Would you...?
Return to your home as soon as the hurricane is over Wait until officials say it is safe to go back Don't Know
18) Below is a list of reasons some people might have for not evacuating the area where they live if there were a major hurricane (Cat 2 or higher). For each one, please indicate if it is a reason why you (would not /might not) evacuate.
a.) You don’t know where to go Yes No Don't Know
b.) You don’t have a car or know anyone who could give you a ride Yes No Don't Know
c.) You have medical or physical problems that would make it difficult to leave Yes No Don't Know
d.) You have to take care of someone who would be physically unable to leave Yes No Don't Know
e.) You would be worried your possessions would be stolen or damaged if you left Yes No Don't Know
f.) You would not want to leave your pet Yes No Don't Know
g.) You would not be able to afford to leave Yes No Don't Know
h.) You would not be able to leave your job Yes No Don't Know
i.) You think your home is well-built and you will be safe at home. Yes No Don't Know
j.) You think evacuating would be dangerous Yes No Don't Know
k.) You think the roads would be too crowded to leave Yes No Don't Know
19.) If a major hurricane (Cat 2 or higher) were to hit our community and for whatever reason you did not leave your home, how confident are you that you would be rescued if you needed to be? Very Somewhat Not Too Not at all Don't Know
20) Do you or any other household members have any pets in your home, such as dogs, cats, birds and the like? Yes, have pets No, do not have pets Don't Know
21) If you had to evacuate because of a hurricane, do you have a place you can go where you can take your pet, or not? Yes, have a place to go and take pet No, do not have a place to go and take pets Don't Know
22) Has your family agreed on a phone number outside the region that all members of your immediate family could call in the event of a hurricane if you are unable to communicate, or haven’t you done that? Yes, family has agreed on a phone number outside the region No, haven't done that Don't Know
23) Has your family agreed on a place you could meet after a hurricane is over if you got separated and could not go back home, or haven’t you done that? Yes, family has agreed on a place to meet No, haven't done that Don't Know
24) Has your family agreed on a place you could meet after a hurricane is over if you got separated and could not go back home, or haven’t you done that? Yes, family has agreed on a place to meet No, haven't done that Don't Know
25) If you had to go to an evacuation shelter because of a hurricane, how worried would you be about the conditions and your safety?
26) Below is a list of concerns people sometimes have about going to a hurricane evacuation center or shelter. If you had to go to a shelter because of a hurricane, please tell us how worried you would be about each one.
a)You Would not have enough water to drink - Very Somewhat Not Too Not at all Don't Know
b)You Would not have enough food to eat - Very Somewhat Not Too Not at all Don't Know
c)You wouldn’t have the prescription drugs or medicines that you need - Very Somewhat Not Too Not at all Don't Know
d)You would be threatened by violence - Very Somewhat Not Too Not at all Don't Know
e)You would need medical care and wouldn’t be able to get it - Very Somewhat Not Too Not at all Don't Know
f)The conditions of the shelter would be unsanitary - Very Somewhat Not Too Not at all Don't Know
g)You would be exposed to sick people and could catch their illness - Very Somewhat Not Too Not at all Don't Know
h)The shelter would be too crowded and you would not have any privacy - Very Somewhat Not Too Not at all Don't Know
i)You would have a hard time communicating with family outside of the sheltery - Very Somewhat Not Too Not at all Don't Know
j)You would have special needs that wouldn’t be addressed in the shelter - Very Somewhat Not Too Not at all Don't Know
27) At any time in your life, did you leave your home because of a hurricane, or haven’t you done this? Yes, did leave home No, haven't done this Don't Know
28) Thinking back over the past 20 years was our community threatened or hit by a major hurricane, or not? Yes, community was threatened byor hit by a major hurricane No, community was not threatened Don't Know
29) Was our community damaged by this hurricane? Yes, my community was damaged No, my community was not damaged Community has not been threatened/hit by a major hurricane Don't Know
30) Because of this hurricane, did you leave your home where you lived, or did you stay in your home? Left home Stayed in home Community has not been threatened/hit by a major hurricane Don't Know
31) Thinking about where your home is located, how likely is your home to be flooded or damaged due to wind in a major hurricane? Very Somewhat Not Too Not at all Don't Know
32)Is your home located in an evacuation zone or not, or don’t you know if it is in an evacuation zone? Yes, located in an evacuation zone No, not located in an evacuation zone Don't Know
33) Next are questions about your IMMEDIATE NEIGHBORS. These are the 10 or 20 households that live closest to you. If a major hurricane were to strike your neighborhood and you needed help, how much would you be able to rely on your immediate neighbors? Alot Some Not much Not at all Don't Know
34) Now thinking about your own health status… In general, would you say your health is…? Excellent Very Good Good Fair Poor
35) Do you or does anyone in your household have a chronic illness or disability that would require you to get help if you had to evacuate because of a major hurricane, or not? Yes, someone in household has a chronic illness or disability No, no one in household Don't Know
36) Do you have help lined up for this person with the chronic illness or disability if you need to evacuate because of a major hurricane or not? Yes, have help lined up No, do not have help lined up Don't Know
37) Do you live in a home you or your family own, are you renting a house or apartment, or do you live somewhere else? Live in a single family home Renting a house or apartment Live somewhere else Don't Know
38) What type of a structure do you live in? (i.e. single family home, duplex or multi-family home, an apartment building or condominium) Live in a single family home A duplex or multi-family home An apartment building or condominium A mobile home Don't Know
39) How long have you lived in Ocean City? Less than 1 year 1-5 years 6-10 years 11-20 years More than 20 years Your whole life Don't Know
40) Additional Comments:
