Annual Self-Reliance Questionnaire

It's time again to update our progress in the areas of self-reliance.  This is our annual survey and will help us assess the needs and interests of the members of our ward.  If you haven't already done so, please fill one out and return to me as soon as possible.  Once I have the information, I will post the results as compared to last years stats.  You can either email your responses to me or print out the survey and give to me directly.  All information is kept strictly confidential!

Thanks!

Kristine Guerrero

tovselfreliance@gmail.com

Annual Self-Reliance Questionnaire

List in order of importance the areas you would like to work on where 1 is the most important and 7 the least.

______ Employment 

______ Food Storage 

______ Gardening 

______Finances  

______ Education and Literacy

______ Physical Health

______ Emergency Planning

______Other (please list) _______________________________________________________

How many months of long term home storage do you estimate you have? It is suggested that we have at least a 1 year supply. _____________________________________________________

How many months of your every day food to you estimate you have?   It is suggested that we have at least a 3 month supply.   _____________________________________________________

How many days/weeks/months worth of water do you estimate you have?  It is suggested that we have at least a 2 week supply.  ______________________________________________________

Please tear here and return to self-reliance committee.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _

Name(s)_______________________________ Email(s)________________________________________

Cell Phone number(s) _____________________________(for emergency situations only not to be shared)

Please check lf you have any of the following.  Use the back of this page for additional space if needed.

_____CPR and first aid training, if you are in any medical field please specify below

_____Any other emergency training, please list below

_____HAM Radio and/or operator license, please specify below

_____Two-way radio

_____Off road transportation, i.e. motorcycle, 4wd vehicle, ATV, etc. please list below

_____RV/motor home/Van/Truck, etc., please specify below

_____Pool/water filtration, please list below

_____Security training, i.e. police/security, hands on combat/fighting please list below

_____Security/weapons, i.e. firearms, ammunition, etc. please list below

_____Camping and/or cooking equipment, please list below

_____Generator, please list type below

Please list any specific area of talents, interests, training, education, skills, etc. not listed above (mechanical, electrical, plumbing, lifeguard, child care, accounting, computers, food handling, gardening/ farming, etc.).