Likely emergency to plan for Severe weather, hurricane, tornado, or flood Wildfire, smoke, or poor air quality Winter storm, ice, or prolonged cold Power outage or utility disruption Not sure or multiple risks
Current plan status No written plan yet Some notes, but not tested Written plan exists Plan was reviewed or practiced recently Not sure
Living situation Lives alone at home Lives with family or friends Senior apartment or multi-unit building Assisted living, memory care, or nursing home Rural, remote, or hard-to-reach area
Mobility or transfer support Usually independent Uses cane, walker, wheelchair, scooter, or lift Needs another person for transfers or stairs Bedbound or cannot evacuate without arranged help Not sure
Electricity-dependent needs No electricity-dependent medical need CPAP, oxygen, dialysis supply, refrigerated medicine, or powered mobility Life-support, oxygen concentrator, ventilator, or critical device Not sure
Medicine and supply readiness Updated list and backup supply are ready Medicine list exists, backup supply unclear List, refills, pharmacy, or refrigeration plan need work Not sure
Memory, communication, or sensory need No extra communication support needed Hearing, vision, speech, or language support Dementia, confusion, wandering, or distress risk Both communication and memory support Not sure
Transportation plan Primary and backup ride are confirmed Family ride planned, no backup yet Transit, paratransit, facility, or local program may be needed May need EMS, medical transport, or lift assistance No ride plan yet
Shelter option Likely shelter at home if safe Family or friend home identified Public shelter may be needed Medical needs shelter or facility support may be needed Not sure
Support network Two or more helpers know the plan One helper knows the plan Facility, agency, or building staff should coordinate Support network needs to be built Not sure
Use this before storms, evacuations, outages, or local emergencies.
Do not enter names, addresses, birth dates, diagnosis details, Medicare numbers, Social Security numbers, account numbers, exact medicine names, passwords, door codes, or private medical records. Keep the real emergency plan in a secure private place shared only with trusted helpers.
This planner is educational and organizational only. It is not medical, emergency-response, legal, insurance, benefits, transportation, facility-placement, or disaster-response advice. Follow instructions from local emergency management, qualified clinicians, facilities, utilities, and first responders.
Official references:
Ready.gov older adults ,
Ready.gov make a plan ,
NIA disaster preparedness ,
ACL emergency preparedness ,
HHS emPOWER ,
Alzheimer's Association disaster preparedness .
