South Jordan Country Crossing Neighborhood Emergency Preparedness Survey

Please verify you are in the coverage area before completing this survey by checking the Coverage Area google map:
Coverage Area
Each South Jordan Emergency Response Area is handled separately. If you live outside the South Jordan Country Crossing Area, please check with South Jordan City, your HOA or neighborhood association to see if they have an EP&R plan.

This is a voluntary survey designed to help you and your neighbors prepare for potential disasters. The information you provide will be kept confidential. It will only be used in the event of an emergency. In times of crisis, it's essential to utilize all available resources. By sharing your skills, training, and capabilities, you can play a crucial role in helping our community respond effectively to disaster situations. Your participation will help ensure that we are better equipped to assist one another when it matters most. Thank you for helping us build a safer, more resilient neighborhood.

Name:
#In Household: 0 12345678910
Has Basement
Street Address:
Street Address2:
Cell Phone:
Email:
Keep Me Informed By Email:
Text Emergency Notifictions:

Home Mostly	Names at Residence	Birth Year	Sex	96 Hour Kit	Cell Phone	School/Work Name	School/Work Phone
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM
			FM

Has Family Emergency Plan
Has Emergency Car Kit
Has Copy of Important Documents

Special Needs: (hold down ctrl for multi select)

Other Needs:

Pet Type	Pet Name

Has Pet Kit
Has Pet Food/Water

Will help with: (hold down ctrl for multi select)


Note, children other than the legal guardian must be listed in Skyward as an emergency contact to recover a child from thier school!

Neighbor you trust to watch your children if you are unavaiable:

• Name:
  Phone:
• Name:
  Phone:
• Name:
  Phone:

Out of Area Emergency Contact:

• Name:
  Phone:
  Relationship:

• Name:
  Phone:
  Relationship:

Equiptment and Skills Inventory: (hold down ctrl for multi select)


What would make you feel more prepared should a disaster happen while you were at home?

Additional Skills / Equiptment:


Submit