Survey - Noah's Ark Home Preparedness

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Are you prepared for 40 days and 40 nights?

Fill out the evaluation form to receive an introductory call.

The following evaluation form will help us best assess your needs.

Evaluation Form

Please help us determine your current level of readiness by answering the following questions:

1. Have you ever experienced a major earthquake?:

Yes No

How old is your home?:

Do you have space to store food and water?:

Yes No

2. In the event of a major disaster, are there any friends or relatives that may need to stay with you?:

Yes No

3. What are the ages of everyone living with you?:

4. Does anyone in your family have any chronic medical conditions?:

Yes No

Does anyone in your household have first-aid training?:

Yes No

5. What type of vehicle(s) do you currently own? (Model / Year):

6. Do you have pets?:

Yes No

7. Do you have a policy in place about not opening doors for strangers?:

Yes No

8. Does every member of your family have a valid passport?:

Yes No

9 How long could your family live on the current contents of your pantry?:

10. On a scale of 1-10 how well prepared would you say your family is for the following events:
(1=completely unprepared / 10=fully prepared):

Earthquake:

1 2 3 4 5 6 7 8 9 10

Fire:

1 2 3 4 5 6 7 8 9 10

Interruption of city services (police / fire / EMS / power / water / gas / waste disposal):

1 2 3 4 5 6 7 8 9 10

Major interruption of food distribution:

1 2 3 4 5 6 7 8 9 10

Name

Telephone

Contact Us

Schedule your in-home or Zoom preparedness training today.

(310) 827-6624

Rod@NoahsArkPrep.com

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