NAME: NAME: NAME: Physician Contact info: Physician Contact info: Physician Contact info: Group # Group # Group # Health Insurance Carrier
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1 NAME: NAME: NAME: Cell: Emergency: Cell: Emergency: Cell: Emergency: Birthday: Blood Type: Birthday: Blood Type: Birthday: Blood Type: Health Insurance Carrier Health Insurance Carrier Health Insurance Carrier Group # Group # Group # Disabilities Conditions Disabilities Conditions Disabilities Conditions Pharmacy Pharmacy Pharmacy
2 72-Hour Kit: Adult CHecklist Name: Each family member needs nine meals. Pack three Ziploc bags with one full day s worth of food and then place all three in a larger container with the other items listed below. Cut out the attached ID card and include it in your kit. Mobile: Emergency: Trail Mix/Dried Fruit Crackers/Cereals Canned Beans, Tuna, Chicken, Vienna Sausages or MREs (Tip: Avoid Pop-Top cans) Canned Juice Candy/Gum (Tip: Avoid mint flavored items and anything that might melt.) Spoon/Fork/Knife/Cup/Bowl/Plate CLOTHING Short sleeved shirt Long sleeved shirt Undergarments Trousers Socks Sturdy Shoes Lightweight Jacket Coat, Hat, Gloves & Other Cold Weather Gear Rain Poncho Headlamp and Charged Batteries Sunglasses Work Gloves Watch Reflective Vest PERSONAL SUPPLIES & MEDICATION Prescription Eyeglasses Hearing Aid Earplugs Sunscreen Tissues Toothbrush/Toothpaste/Dental Floss Toilet Paper Wipes N95 Respirator Mask (NIOSH Approved) Feminine Hygiene Supplies Hand Sanitizer Soap Lotion Small Notebook and Pencil Blanket or Sleeping Bag Cloth Sheet Plastic Sheet, Tarp or Tent Birthday: Blood Type: Health Insurance Carrier: Group #: Disabilities Conditions: Pharmacy
3 72-Hour Kit: infant CHecklist Name: Each family member needs nine meals. Pack three Ziploc bags with one full day s worth of food and then place all three in a larger container with the other items listed below. Cut out the attached ID card and include it in your kit. Mobile: Emergency: Crackers/Biscuits Baby Cereal Baby Food Formula Spoon/Bowl/Bottle CLOTHING Short sleeved shirt Long sleeved shirt Undergarments Trousers Socks Sturdy Shoes Lightweight Jacket Coat, Hat, Gloves & Other Cold Weather Gear Rain Poncho Sunglasses PERSONAL SUPPLIES & MEDICATION Tissues Cotton Swabs Wipes Diapers Soap Lotion/Diaper Cream Sunscreen Comb/Hairbrush Respirator Mask (NIOSH Approved) Small Toy/Teething Ring Pacifier/Soother Blanket Cloth Sheet Plastic Sheet or Tarp Carrier/Sling Car Seat Birthday: Blood Type: Health Insurance Carrier: Group #: Disabilities Conditions: Pharmacy
4 72-Hour Kit: child CHecklist Name: Each family member needs nine meals. Pack three Ziploc bags with one full day s worth of food and then place all three in a larger container with the other items listed below. Cut out the attached ID card and include it in your kit. Mobile: Emergency: PERSONAL SUPPLIES & MEDICATION Birthday: Blood Type: Trail Mix/Dried Fruit Crackers/Cereals Canned Beans, Tuna, Chicken, Vienna Sausages or MREs (Tip: Avoid Pop-Top cans) Canned Juice Candy/Gum (Tip: Avoid mint flavored items and anything that might melt.) Spoon/Fork/Knife/Cup/Bowl/Plate CLOTHING Short sleeved shirt Long sleeved shirt Undergarments Trousers Socks Sturdy Shoes Lightweight Jacket Coat, Hat, Gloves & Other Cold Weather Gear Rain Poncho Headlamp and Charged Batteries Sunglasses Watch Reflective Vest Prescription Eyeglasses Hearing Aid Tissues Toothbrush/Toothpaste/Dental Floss Toilet Paper Wipes N95 Respirator Mask (NIOSH Approved) Hand Sanitizer Soap Lotion Sunscreen Coloring Book and Crayons Toys Comb/Hairbrush Deck of Cards Blanket or Sleeping Bag Cloth Sheet Plastic Sheet, Tarp or Tent Health Insurance Carrier: Group #: Disabilities Conditions: Pharmacy
5 72-Hour Kit: pet CHecklist Your pet needs enough food for three days. Pack 3 Ziplock bags with one full day s worth of food and treats and then place all three in a larger container with the other items listed below. Cut out the attached ID card and include it in your kit. Food and Treats for 3 Days Water/Food Dishes NOTES I M LOST! My Name: Owners Name: SUPPLIES & MEDICATION Extra collar/leash set Reflective Vest Poncho Coat or Other Cold Weather Gear Chew Toy Metal Stake and Tie Down Leash Nylon Rope Pet Waste Bags Cell: Microchip #: Age: Breed: Vet Name: Blanket or Sleeping Bag Plastic Sheet, Tarp or Tent
6 72-hour kit: household & car checklist MONEY & IMPORTANT DOCUMENTS Homeowners Insurance Information Health Insurance Information Birth/Marriage Certificates Wills Passports Contracts Vaccination Papers Photos of Family Members and Pets Extra Keys to Your House and Vehicles Inventory and photographs of your valuables ID Card for each member of your family with name, age, medications, allergies, etc. Cash (in small bills and change) Credit Card Prepaid Phone Card HOUSEHOLD EQUIPMENT Adjustable Wrench Axe/Hatchet Batteries Binoculars Bungee Cords Camp Stove/Fuel/Lighter Candles/Waterproof Matches Charcoal/Lighter Compass Crowbar Disposable Camera Duct Tape First Aid Guide First Aid Kit Over The Counter Medications & Supplies Pain Relief Children s Pain Relief Benadryl Children s Benedryl Aspirin Small Bottle of Bleach Thermometer Medical Gloves and Face Masks Flares Flashlight Funnel Garbage Bags Gas Shutoff Tool Gasoline Generator Hammer Lighters/Waterproof Matches Local Map Mirror Nails Permanent Marker, Paper, Tape Plastic Bags / Ziploc Bags Plastic Bucket / Portable Toilet Plastic Sheeting Plates, Utensils and Other Feeding Supplies Playing Cards Propane Tank Rope Self-Generated Radio Compact, Multi-Function Shovel Scissors Solar Charger for Mobile Devices Staple Gun Super Glue Survival Knife Two-Way Radio/Charged Batteries Utility Knife Whistle EMERGENCY KIT CHECKLIST CAR Bungee Cords Duct Tape Flare Oil Funnel Reflective Safety Vest Reflective Triangle Seatbelt Cutter Shovel Tire Pressure Gauge Tire Puncture Seal Tow Rope Window Breaking Tip
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