Communications: Household Communications Form
Date:
When an emergency happens
Text a household member with your status. Say, for example, “I’m ok and I’m at [location].”
Text or call out-of-state contact with your status. Say, for example, “I’m ok and I’m at [location].”
Household Members
Name: Phone Number:
Name: Phone Number:
Name: Phone Number:
Name: Phone Number:
Name: Phone Number:
Name: Phone Number:
Name: Phone Number:
Out-of-State Contact
Name: Phone Number:
In-State Contacts
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Name: Phone Number:
Address:
List of Approved Adults for Child
Name: Phone Number:
Address:
Name: Phone Number:
Address
Name: Phone Number:
Address:
Name: Phone Number:
Address:
List of Approved Caregivers for Dependent Senior Adults
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Name: Phone Number:
Address:
List of Approved Caregivers for Domestic Animals
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Name: Phone Number:
Address:
Communications Technology
☐ Handheld radios
Practice
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Cell phone
Practice
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Satellite phone
Practice
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Satellite text devices
Practice
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Ham radio
Practice
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date:
☐ Name: Date: