Each person with the disability or need should accomplish what is called a personal support network contact list (family members, attendants, neighbors...)
This is a sample and should be adjusted to fit the needs of the person. Add additional contacts as needed. Set these recommendations up on a word document or spread sheet.
Checklist and Personal Assessment:
During an emergency, this checklist will enable emergency responders to better assist you.
I am able to:
Walk without help?
Walk with help?
Prepare my meals?
Sit without help?
Wash/bath without help?
Wash/bath with help?
Sanitary needs without help?
Sanitary needs with help?
I need specific help with (explain).
Personal Support Network Contact List (Family members, Attendents, neighbors...)
Other Special Needs:
Health Card #
Out-of-town emergency contact:
Household pet care:
Local emergency management contact (for your area):
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