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How to Create a Disaster Survivor’s Checklist

Storm Preppers - How to Create a Disaster Survivor’s Checklist

The Federal Emergency Management Agency (FEMA) created a Disaster Survivor’s Checklist to assist United States residents affected by disasters. Although the checklist references specific FEMA resources, it is very useful if you want to create one for your neighbourhood, parish, state or country.

This checklist is an excellent complement to the Special Needs Registry which allows the authorities to track residents who may need assistance before, during and after a disaster event. The Disaster Survivor’s Checklist becomes useful after the event in cases where residents require assistance. For example, FEMA’s Disaster Survivor’s Checklist, which is an integral tool in the disaster survivor assistance, allows second responders to assist to disaster survivors in a timely manner.

The Disaster Survivor’s Checklist

To create a Disaster Survivor’s Checklist, you should outline the main questions that you will ask survivors. The answers to these questions will allow second responders to identify the type of assistance required and who the requests should be directed to.

Alternatively, you can download a free copy of the Storm Preppers Disaster Survivor’s Checklist. Fields to be completed in the form are noted below:

Personal Information

The personal information section contains basic information about the registration. Fill out the fields as stated on your personal identification card. Complete all fields in the section. The fields are:

  • Last Name
  • First Name
  • Middle Initial
  • Sex
  • Date of Birth
  • Age

Contact Information

In the contact information section, enter your preferred contact methods. Complete all fields in this section. Available fields are:

  • Address
  • Home Phone
  • Mobile Phone
  • Email

Household Needs

The Household Needs section is an assessment of the property that has been damaged. Property includes a building or dwelling (e.g. home, business) or a vehicle (e.g. car, truck, motorcycle, bicycle, boat). Describe the damage to your property and provide photos if possible. Answer all questions in this section.

Personal Needs

In the Personal Needs section, the applicant will outline their immediate personal needs (if there are any). These are the things that the applicant needs to survive in the aftermath of the disaster event.

Acknowledgement and Consent

The applicant must read, agree, and sign off on the form, thus certifying that the information provided is true and correct. The acknowledgement and consent statement absolve the reporting agency from any legal action. A representative of the agency will complete the “For Official Use Only” section.


FEMA: Disaster Survivor’s Checklist
FEMA: Individual Assistance Program Fact Sheet
Disaster Assistance: Get Assistance – Application Checklist
Florida Disaster: Needs Questionnaire
Florida Disaster: Needs Submission