Phase One - Hazard Identification - Across the country businesses are vulnerable to many types of hazards. Rate these hazards in terms of possible impact on your business.

	Critical	Very Important	Important	Not Very Important	Not A Threat
Avalanche
Civil Disturbance
Coastal Erosion
Coastal Storm
Dam Failure
Drought
Earthquake
Extreme Heat
Fire
Flood
Freezing Weather
Hailstorm
Hazardous Materials Accident
Hurricane
Landslide
Lightning
Nuclear Power Plant Accident
Severe Winter Weather
Sink Hole
Tornado
Transportation Accident
Tsunami
Volcano
Wildfire
Windstorm

Phase Two - Vulnerability Assessment - Service Interruption

	Critical	Very Important	Important	Not Very Important	Not A Threat
Electricity
Natural Gas
Phone / Internet
Sewer
Transportation
Water
Building Damage
Equipment Damage
Loss of Customers
Loss of Data, Documents or Records
Loss of Inventory
Loss of Public Access - Street Closures
Loss of Staff
Loss of Suppliers or Vendors
Negative Publicity about your Business or the Surrounding Neighborhood

Phase Three - Disaster Planning - In your business, have you:

	Have Done	Plan To Do	Unable To Do	Will Not Do
Attend meetings or received written information on disaster preparedness?
Conducted disaster drills or exercises for your employees?
Developed a Business Emergency Response Plan?
Developed a Business Disaster Recovery Plan?
Made arrangements to relocate to another site in case of disaster damage or accessibility issues?
Obtained backup systems (i.e. generator etc.)?
Performed disaster structural retrofit measures to your building?
Prepared and stored a Disaster Supplies Kit?
Purchased Business Interruption Insurance?
Purchased Earthquake Insurance?
Purchased Flood Insurance?
Stored critical business data off-site?
Talked with employees about what to do in an emergency?
Trained employees in First Aid and CPR?
Trained employees to evacuate the building safely?
Trained employees to prepare for a disaster at home so they can return to work more quickly?

Phase Four - Disaster Planning - What information or resources would assist you to minimize an interruption to your business? Rate the importance of each to your business and employees:

	Very Useful	Somewhat Useful	Not Useful	Addressed
Alternate communications!
Alternate route availability!
Alternate shipping and / or transportation!
Back-up sources of electricity!
Disaster preparedness mentoring program between businesses!
Help employees make plans to protect themslves, families and their homes!
How to access resources such as equipment, counseling, volunteers, financial advice etc.!
How to communicate your business recovery plans with your suppliers and customers!
How to coordinate your efforts with others affected by a disaster (in your building, neighborhood etc.)!
How to practice your business recovery strategy!
How to select appropriate business interruption insurance for your business!
Once business has completed preparedness activities, receive "Disaster Resistant Business" designation and public recognition!
Post disaster inspections!
Preparedness training for employees (evacuating a building, fire safety, First Aid and CPR etc.)!
Protecting data, building, contents and equipment from damage and / or loss!
Receiving permits to retrofit or repair your building!
Road access and debris removal!
Sharing resources among businesses in an emergency situation (Mutual Aid)!
Talking with your building manager or owner about business emergency response plans and access to your building post disaster!
Work with similar businesses on disaster mitigation projects!

Phase Five - Organization Profile - Basic information on your organization.

Name:
Business / Organization Name:
E-Mail Address: (Required)
State:
County: