Family Disaster Plan Checklist NURS 431 Disaster Management
Assignment Instructions:
Complete your Family Disaster Plan Checklist
1. Complete all sections I - VIII. Use yes, check marks or x's for items you do have. Use need or no for
items you do not have currently. Use N/A, for items not applicable for your living situation. Do not
leave anything blank.
2. Complete Section I. - “My Family’s Disaster Plan-Potential Hazards”. Include your reference and in-
text citations.
3. Remember to protect personal information by using pseudonyms, or by providing only partial
information.
o Ex: Sister: Britley *****, phone: 724-***-****, email: b********@yahoo.com
4. Use complete information for utility companies, public companies, and agencies.
5. Review the rubric for more information on how the assignment will be graded.
Please note: You are not required to purchase any items on this list, however, take note of the
items you are missing and consider how it could impact your safety and survival in a disaster.
You will use this Family Disaster Plan Checklist to build your 72-Hour Go Bag photo for the
Week 7 Discussion Board and for your Week 8 Summative Assessment paper.
____________________________________________________________________________
Name: Date: Revise Date:
(For now, your Revise Date will be 1 year from
your assignment dated. Then it will be annually
unless you have life changes.)
One of the most important steps you can take in preparing for emergencies is to develop a
household disaster plan. This involves creating a plan that identifies who you can contact in an
emergency, what each member of your family must do, and how you can better prepare
yourself for the situation. (Veenema, 2009)
I. My Family’s Disaster Plan – Potential Hazards
Research potential disasters that could occur in your community. Select 2 (two) potential disasters and
using about 25 words, examine how these potential disasters can impact you in your work as a nurse.
Provide at least 1 reference for each potential disaster. Use APA Style for your reference(s) and include
in-text citation(s). Write your word count at the end of your paragraph for each possible hazard.
# 1-Possible hazards in my area:
Flooding can block roads, delay emergency response, raise incidence of waterborne illnesses, cut off
supplies of electricity to power nurses, which makes it more difficult for nurses to give timely, effective
patient care (Luca Theresa Wiesehahn & Kaifie, 2024). [39 WORDS]
Reference: Luca Theresa Wiesehahn, & Kaifie, A. (2024). The impact of the 2021 flood on the outpatient
care in the North Rhine region, Germany: a cross-sectional study. BMC Public Health, 24(1).
https://doi.org/10.1186/s12889-023-17279-y
# 2-Possible hazards in my area:
5- Revised 2023 Fall 2
,Family Disaster Plan Checklist NURS 431 Disaster Management
Mass injuries are caused by tornadoes, which damage hospitals, disrupt power, and overwhelm
emergency rooms so that nurses need to deal with trauma patients in extreme working conditions and
limited resources (Cong & Liang, 2022). [35 word]
Reference
Cong, Z., & Liang, D. (2022). Health and Mental Health Impact of Tornadoes: Are Older Adults More
Resilient? International Journal of Mass Emergencies & Disasters, 40(2), 136–154.
https://doi.org/10.1177/028072702204000202
II. Emergency Contact Information and Communication Plan
Emergency Phone Numbers - (Program these into all phones and post in a common area in the
home.)
Address Phone #
Police Department 334 S. Hall St., Dallas, TX 214-670-4413 (non-
75226 emergency)
Fire Department 1500 Marilla Street 214-670-3111
Dallas, TX 75201
Local Emergency Services 1500 Marilla St L2AN, Dallas, TX 911
75201
Local American Red Cross 4800 Harry Hines Blvd., 214-678-4800
Dallas, TX 75235
Poison Help Nationwide Service 1-800-222-1212
Healthcare Providers
Doctor Oak Lawn Medical Center, (708) 425-5500
3500 Oak Lawn Ave., Dallas,
TX 75219
Dentist Uptown Dental Studio, 2727 (214) 427-1941
Oak Lawn Ave., Dallas, TX
75219
Other (add additional Local Pharmacy, CVS (214) 361-7118
important personal Pharmacy, 8335 Westchester
contacts) Drive Dallas, TX 75225
Employers and School Officials Contacts
I know the emergency response plans for employers and schools. _____
Self, Spouse, Employer/School Address Phone # Facility Contact
Significant Other Name
(names)
Josh *** Baylor University *** Gaston 214-8**- HR Manager
Medical Center Ave., ****** ***
Hasii *** Highland Park High **** Emerson 214-7**- School Principal
School Ave., ******** ****
Child’s Name Child Day Care/Child Address Phone # Facility Contact
5- Revised 2023 Fall 2
, Family Disaster Plan Checklist NURS 431 Disaster Management
School Name
Emiii **** Oak Lawn ***** Oak Lawn 214-5***-*** School Director
Montessori School Ave., ****
Family Communication Plan
Prepare a family communication plan so that each member of the family can contact one another
quickly. (Put 10 most important numbers on a card in your wallet.)
Everyone has a cell phone or calling card _____
Young children know how to call (numbers are saved and they also have the 10 most
important numbers on a card in their backpack.) ______
10 most Name Address Phone Email
important
numbers
911
1 N/A 911 N/A
(Emergency)
334 S. Hall
Dallas Police 214-744-
2 St., Dallas, N/A
Dept 4444
TX 75226
1551 Baylor
Dallas Fire 214-670-
3 St., Dallas, N/A
Dept 5466
TX 75226
1-800-
Nationwide
4 Poison Control 222- N/A
Service
1222
6201 Harry
Local Hospital
Hines Blvd., 214-633-
5 (UT
Dallas, TX 5555
Southwestern)
75235
4301 West
(708)
95th Street,
6 Family Doctor 425-
Oak Lawn,
5500
IL 60453.
Family 2801 Allen
214-8**-
7 Member (Josh St., Dallas, ****
TX 75204
***
***)
Family ***** Allen
214-7**-
8 Member St., Dallas, ***
****
(Hashi ***) TX ****
*** St.,
Close Friend 214-5**-
9 Dallas, ****
(Mike *****) ****
****
Neighbor ***** St., 214-9**-
10 ****
(Sarah ***) Dallas, ****
5- Revised 2023 Fall 2
Assignment Instructions:
Complete your Family Disaster Plan Checklist
1. Complete all sections I - VIII. Use yes, check marks or x's for items you do have. Use need or no for
items you do not have currently. Use N/A, for items not applicable for your living situation. Do not
leave anything blank.
2. Complete Section I. - “My Family’s Disaster Plan-Potential Hazards”. Include your reference and in-
text citations.
3. Remember to protect personal information by using pseudonyms, or by providing only partial
information.
o Ex: Sister: Britley *****, phone: 724-***-****, email: b********@yahoo.com
4. Use complete information for utility companies, public companies, and agencies.
5. Review the rubric for more information on how the assignment will be graded.
Please note: You are not required to purchase any items on this list, however, take note of the
items you are missing and consider how it could impact your safety and survival in a disaster.
You will use this Family Disaster Plan Checklist to build your 72-Hour Go Bag photo for the
Week 7 Discussion Board and for your Week 8 Summative Assessment paper.
____________________________________________________________________________
Name: Date: Revise Date:
(For now, your Revise Date will be 1 year from
your assignment dated. Then it will be annually
unless you have life changes.)
One of the most important steps you can take in preparing for emergencies is to develop a
household disaster plan. This involves creating a plan that identifies who you can contact in an
emergency, what each member of your family must do, and how you can better prepare
yourself for the situation. (Veenema, 2009)
I. My Family’s Disaster Plan – Potential Hazards
Research potential disasters that could occur in your community. Select 2 (two) potential disasters and
using about 25 words, examine how these potential disasters can impact you in your work as a nurse.
Provide at least 1 reference for each potential disaster. Use APA Style for your reference(s) and include
in-text citation(s). Write your word count at the end of your paragraph for each possible hazard.
# 1-Possible hazards in my area:
Flooding can block roads, delay emergency response, raise incidence of waterborne illnesses, cut off
supplies of electricity to power nurses, which makes it more difficult for nurses to give timely, effective
patient care (Luca Theresa Wiesehahn & Kaifie, 2024). [39 WORDS]
Reference: Luca Theresa Wiesehahn, & Kaifie, A. (2024). The impact of the 2021 flood on the outpatient
care in the North Rhine region, Germany: a cross-sectional study. BMC Public Health, 24(1).
https://doi.org/10.1186/s12889-023-17279-y
# 2-Possible hazards in my area:
5- Revised 2023 Fall 2
,Family Disaster Plan Checklist NURS 431 Disaster Management
Mass injuries are caused by tornadoes, which damage hospitals, disrupt power, and overwhelm
emergency rooms so that nurses need to deal with trauma patients in extreme working conditions and
limited resources (Cong & Liang, 2022). [35 word]
Reference
Cong, Z., & Liang, D. (2022). Health and Mental Health Impact of Tornadoes: Are Older Adults More
Resilient? International Journal of Mass Emergencies & Disasters, 40(2), 136–154.
https://doi.org/10.1177/028072702204000202
II. Emergency Contact Information and Communication Plan
Emergency Phone Numbers - (Program these into all phones and post in a common area in the
home.)
Address Phone #
Police Department 334 S. Hall St., Dallas, TX 214-670-4413 (non-
75226 emergency)
Fire Department 1500 Marilla Street 214-670-3111
Dallas, TX 75201
Local Emergency Services 1500 Marilla St L2AN, Dallas, TX 911
75201
Local American Red Cross 4800 Harry Hines Blvd., 214-678-4800
Dallas, TX 75235
Poison Help Nationwide Service 1-800-222-1212
Healthcare Providers
Doctor Oak Lawn Medical Center, (708) 425-5500
3500 Oak Lawn Ave., Dallas,
TX 75219
Dentist Uptown Dental Studio, 2727 (214) 427-1941
Oak Lawn Ave., Dallas, TX
75219
Other (add additional Local Pharmacy, CVS (214) 361-7118
important personal Pharmacy, 8335 Westchester
contacts) Drive Dallas, TX 75225
Employers and School Officials Contacts
I know the emergency response plans for employers and schools. _____
Self, Spouse, Employer/School Address Phone # Facility Contact
Significant Other Name
(names)
Josh *** Baylor University *** Gaston 214-8**- HR Manager
Medical Center Ave., ****** ***
Hasii *** Highland Park High **** Emerson 214-7**- School Principal
School Ave., ******** ****
Child’s Name Child Day Care/Child Address Phone # Facility Contact
5- Revised 2023 Fall 2
, Family Disaster Plan Checklist NURS 431 Disaster Management
School Name
Emiii **** Oak Lawn ***** Oak Lawn 214-5***-*** School Director
Montessori School Ave., ****
Family Communication Plan
Prepare a family communication plan so that each member of the family can contact one another
quickly. (Put 10 most important numbers on a card in your wallet.)
Everyone has a cell phone or calling card _____
Young children know how to call (numbers are saved and they also have the 10 most
important numbers on a card in their backpack.) ______
10 most Name Address Phone Email
important
numbers
911
1 N/A 911 N/A
(Emergency)
334 S. Hall
Dallas Police 214-744-
2 St., Dallas, N/A
Dept 4444
TX 75226
1551 Baylor
Dallas Fire 214-670-
3 St., Dallas, N/A
Dept 5466
TX 75226
1-800-
Nationwide
4 Poison Control 222- N/A
Service
1222
6201 Harry
Local Hospital
Hines Blvd., 214-633-
5 (UT
Dallas, TX 5555
Southwestern)
75235
4301 West
(708)
95th Street,
6 Family Doctor 425-
Oak Lawn,
5500
IL 60453.
Family 2801 Allen
214-8**-
7 Member (Josh St., Dallas, ****
TX 75204
***
***)
Family ***** Allen
214-7**-
8 Member St., Dallas, ***
****
(Hashi ***) TX ****
*** St.,
Close Friend 214-5**-
9 Dallas, ****
(Mike *****) ****
****
Neighbor ***** St., 214-9**-
10 ****
(Sarah ***) Dallas, ****
5- Revised 2023 Fall 2
