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Describe your facility (e.g. We occupy the 1st and 2nd floor of a 10 story building in St. Louis or we occupy a single story stand alone building in Chicago).
   
 
 
 
The name and title of the person completing this questionnaire.
   
 
 
 
What is your physical address?
   
 
 
 
Does your building have? Check all that apply
 
Fire alarm
 
Fire alarm automatically notifies fire dispatch
 
Fire alarm notifies building security only
 
Sprinklers
 
Elevators
 
Back-up generators
 
Basement or severe weather shelter
 
NOAA weather radios
 
Designated emergency assembly point outside in case of evacuation

 
 
 
Does your office have predesignated emergency response team members, people responsible for evacuation and accountability, or emergency coordinators?
   
 
 
 
Type of security on site(Select all that apply)?
 
DirecTV security officers
 
Building security officers
 
No security on site

 
 
 
Please select the hazards that you feel apply to your location (Select all that apply)?
 
Tornado
 
Severe wind or hail
 
Flood
 
Severe winter weather
 
Hurricane
 
Earthquake
 
Wildfire
 
Aircraft crash
 
Tsunami
 
Bomb threat
 
Armed Assailant
 
Other
 

 
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