Emergencies can happen to anyone, anywhere, and at any time. Emergencies take many forms, such as fires, hazardous material spills, power outages, natural disasters and even terrorism. The Bath County Local Emergency Preparedness Committee (LEPC) conducted a hazardous vulnerability assessment which determined that natural disasters, such as flooding caused by hurricanes and winter storms are the most likely cause of disaster in this area. Nevertheless, Bath County is preparing for emergencies by using the "all hazards" approach to the planning, mitigation, response, and recovery of a disaster.
We all hear more and more information about being prepared. Basic preparedness tips include: assemble a disaster supply kit and plan for your home and family; determine a "shelter in" place and procedure; know the preparedness plans in your area (work, school, community); and know what to do in an evacuation. You are the most important part of the success of your plan.
Another component of emergency preparedness is to identify individuals with disabilities and special needs. Examples include persons with hearing or visual impairments, wheelchair bound or limited mobility, on oxygen, home-bound, no access to transportation, and any other disability or limitation. Individuals that live alone with a limited support system are at an increased level of risk in an emergency.
Bath Co. LEPC began and will continue a county-wide effort to educate, identify and keep updated, our special needs population. The goal is to do all that is possible to make assistance more readily available should it be needed during a disaster.
One goal of this effort is to develop and maintain a registry that lists the special needs population. For this purpose the LEPC is asking that you complete and return the Registration Form included in this packet to LEPC member Debbie Michael at Bath County Social Services, P. O. Box 7, Warm Springs, Va. 24484. If you need assistance to complete this form, want additional information or have questions you may call 839-7271 or 888-823-1710, or e-mail deborah.michael@dss.virginia.gov. The choice to register is entirely yours and your information will not be shared for any other purpose. However, this registry will ultimately be a part of the 911 emergency system. If you prefer, you may contact Teresa Phillips at 839-7287, 888-823-1710 or e-mail bath911@bathcountyva.org to register directly with the 911 emergency system. While you and your personal planning are the most critical part of this process, sharing your needs and plans will help assure you receive the help you need during an emergency.
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Bath County Local Emergency Planning Committee (LEPC)
Emergency Special Needs Registration Form
(Please print out the form, fill it in, then mail. Please see
instructions below)
Head of Household
Name _________________________________________ Phone _________________
911 Address ____________________________________________________________
Mailing Address (if different) _______________________________________________
E-Mail ________________________________________
Age or DOB _____________
Household Members
____________________________________
___________________________________
Name
Age Name
Age
____________________________________
___________________________________
Name
Age Name
Age
____________________________________
___________________________________
Name
Age Name
Age
Emergency
Contacts (Preferably one
out of town)
__________________________
___________________________ _________________
Name
Address
Phone
__________________________
___________________________ _________________
Name
Address
Phone
Do you have
transportation? ___
No ___
Yes - If yes, please specify
what means:
___ Own car
& drive ___ Have car but don’t drive
___ Neighbor/friend/relative
&
please give name and phone # ______________________________________________
Other __________________________________________________________________
Do you have pets?
___ No ___
Yes If yes, please
list:_________________________
________________________________________________________________________
What is your
disability or special need?
___ Hearing
impaired ___ Walker/cane required
___ Dialysis
___ Seizures
___ Vision
impaired ___
Unable to walk ___
Diabetic ___
Wheelchair
___ Oxygen Other ______________________________________________________
Do you take prescription medication each day? ___ No ___ Yes Please attach a current list. It would also be helpful to emergency workers to keep a current list posted in a visible place in your home.
Have you gathered
and keep on hand supplies to be used in the event of any emergency?
If so, please briefly describe.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you
developed an emergency plan/”shelter in” place?
____ Yes – Is it posted in a visible place in your home?
Does everyone involved have a copy?
It would be most helpful if you would include a copy with this form
____ No
Any other information you think should be included? __________________________________________________________
My signature on this form indicates that the above
information is true and current and is to be considered as consent for DSS and
E911 to share this information with regard to emergency preparedness.
____________________________________________ ___________________________
Signature Date
Help us to help you. Please return your completed
information to LEPC member Debbie Michael, Bath Co. Social Services, P.O. Box 7,
Warm Springs, Va. 24484. Or, if you
prefer, you may call Teresa Phillips and register directly with the 911
emergency system. If you have questions or desire more information call Debbie
at 839-7271 or Teresa at 839-7287 or either toll free at 888-823-1710.
“Knowing what to do is your best protection and your responsibility.”