Parish Emergency Plan

In this short questionnaire the Parish Council is trying to find out who might need help during an emergency, and who might be able to offer help during an emergency.

Please fill out whichever parts of the questionnaireare appropriate to you. During some types of emergency you might need help; during other types you might be able to offer it.

Please then give the completed questionnaire to a Parish Councillor, or to the Clerk at Waterford House, The Street. Or and ask for a Word copy which you can fill in and email back to us.

You may have previously completed a questionnaire like this, in which case you should have received either a letter or an email asking you to confirm that the details you originally gave are still correct. If you have received such a letter or email please ignore this questionnaire, and we apologise for the duplication. If you think you should have received one and haven’t, please let us know.

What is an emergency?

For the purposes of the Emergency Plan an emergency is an urgent situation which the usual emergency organisations can’t immediately deal with, such as a widespread flood or prolonged power cut.

If you agree to offer help in an emergency you will NOT be contacted to assist with individual cases. The Emergency Plan will only be invoked when it is clear that the emergency services cannot immediately cope - we hope this will never happen! At other times, we would expect a combination of good neighbourliness and the normal emergency services to prevail.

Data Protection

By filling in thisquestionnaire (or confirming details previously given) you are giving permission for the details you provide to be held in the following formats:

  • in a database held online and accessible only to members of the Parish Council Emergency Plan Committee;
  • in paper copies of the database held at the homes of the two responsible Parish Councillors and of the Parish Clerk;
  • in paper copies of the database held in locked boxes at two secure locations (probably the Village Hall and one other).

In addition partial copies of the database, to the extent necessary to carry out their roles, will be accessible to those people appointed as Emergency Plan Team Leaders.

Please note that if you give us your email address it will only be used for contacting you on Emergency Plan matters (unless we already have it for other purposes).

After you have returned the questionnaire we will need to contact you approximately once a year to confirm that the details you have given us are still correct.

When will the Plan come into effect?

We hope the Plan will be completed and tested by the end of 2016; when this is done we will publish outline details of it on the Parish Website, somerfordkeynes.org.uk.

If you have any queries on the Parish Emergency Plan at any time, please email or telephone the Parish Clerk on 861614, and someone will get back to you as soon as possible.

Thank you for taking the time to fill in this questionnaire.

Parish Emergency Plan

Your name:
Address (include postcode):
Email:
Telephone: / Mobile:

1 Might you need help during or just after an emergency?

Please give brief details of any problems you feel you might have in an emergency, eg: poor mobility in snow or flood conditions, medical equipment which might be affected during a power cut, need for repeat prescriptions or medical services.
Someone might get back to you for more information during the next few weeks.

2 Can you offer help during or just after an emergency?(Please note that if you answer ‘Yes’ to any of the following you may be contacted again to discuss details).

Would you be prepared to be a co-ordinator/team leader during an emergency? Please tick
Yes / No
Would you be prepared to act as a member of a ‘communications cascade’ during an emergency? Please tick
Yes / No
Would you be prepared to form part of a team visiting people during an emergency to make sure they are all right? Please tick
Yes / No
Do you have any of the following skills that you are prepared to offer in an emergency? Please tick all that apply
First Aid / Builder / Mechanic
General dogsbody / Plumber / Gas Safe registered
Electrician / HGV License / Catering
Telecommunications
Other (please describe)
Do you have any of the following equipment that you are prepared to offer for use in the event of an emergency? (note: if it is specialised equipment such as a tractor or a chainsaw, we would need the use of a qualified operator as well). Please tick, or give numbers where appropriate
Tractor / JCB / Gas cylinders
Trailer / Lifting gear / Mobile water tank
4x4 Vehicle / Generator / Blankets/Pillows
Emergency Lighting / Portable pump / Camp Beds
Chain saw / Tent / Boat
Other (please describe)
If you would be prepared to offer accommodation to people and/or their pets during an emergency, please provide the following information, giving numbers if applicable:
People Dogs Cats Other pets
What water supply do you have? Please tick all that apply
Mains / Well / Spring / Other
What type of heating do you have? Please tick all that apply (we assume everyone has mains electricity for lighting)
Mains electricity / Oil / Mains gas / Gas cylinder
Wood / Other
What cooking facilities do you have? Please tick all that apply
Electricity / Mains gas / Gas cylinder / Oil
Wood / Camping stove / Other
What type of sewerage system do you have?
Mains / Septic tank requiring mains operated pump / Septic tank not requiring mains operated pump / Other
What type of property do you have?
House / Bungalow / Caravan
Farm / Flat –ground floor/upper / Other
Is there any other way in which you feel you would be able to help during an emergency? Please give brief details.

Template from the GRCC Emergency Planning toolkit July 2009