Debt
1. Are you debt-free? YES NO
(If "yes", skip to section "Food Storage".)
2. Please complete questions indicating what type of debt you have:
a) home mortgage YES NO
b) car YES NO
c) credit card YES NO
d) recreational vehicle(s)YES NO
e) other YES NO
3. Are you actively following a plan to become debt-free?
YES- NO
4. Estimate how many years/months before you become debt-free: __________
Food Storage
5. Do you have a functioning home food storage program? YES NO
6. Approximately how many gallons of water do you have stored (not including water heater, toilet tanks)? _____________
7. Approximately how many pounds of grain and/or legumes do you have stored (rice, wheat, etc)? __________
8. Are you using your storage items on at least a weekly basis? YES NO
9. Are you currently storing rotating food supplies? (canned foods, boxed foods, condiments, etc) YES NO
10. Estimate how many months your family could survive on your overall food storage: _____________
Fuel Storage & Use
Please answer the following as if electricity/natural gas service is disrupted:11. Do you have an alternative heating source? YES NO
(wood burning stove, propane, etc.)
12. Estimate how many days of fuel for such heating you have stored: ________
13. Estimate how many hours lighting you have stored (candles, lanterns, generator, etc.): _________
14. Do you own an alternate cooking device? YES NO
15. Do you own a dutch oven/outdoor cookware? YES NO
Medical Supplies
16. Do you have a family first aid kit? YES NO
Personal Hygiene
17. Do you have detergent/laundry soap stored? YES NO
18. Do you have liquid/bar hand soap stored? YES NO
19. Do you have toilet paper stored? YES NO
20. Do you have paper/cloth towels stored? YES NO
Alternative Dwelling
21. Do you have an alternative dwelling? YES NO
(tent, camper, trailer, etc.)
22. Do you have a 72-hour kit for each family member? YES NO
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