Welcome to the City of Mobile Alabama

The Mobile County Hurricane Evacuation Survey

Questions marked with a * are required.

*1.	Your Name

*2.	Street Address

*3.	City

*4.	Zip Code

5.	Home Phone

*6.	Number of people living in your house

*7.

Do the people living in your house plan to leave the area if called for by the Mobile County Emergency Management Agency (EMA) and local government leaders?

Yes

No

*8.

If you plan to leave, will you go to a local shelter if one is available?

Yes

No

*9.

If you and the people living in your house plan to leave, do you have either personal transportation (car) or a ride with someone?

Yes

No

10.

If you answered NO to the previous question, will you or the people living in your house need help to leave?

Yes

No

11.

If help is needed to leave, is someone in your house: (Select all that apply)

Using a wheel chair

Unable to move from a bed

Using oxygen tanks

Using an oxygen concentrator

Using a portable ventilator

Using a non-portable ventilator

Using an IV pole

Using a dialysis machine

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