Republic of the Philippines

Department of Education
CORDILLERA ADMINISTRATIVE REGION
SCHOOLS DIVISION OF MOUNTAIN PROVINCE
(Enclosure to DepEd Order No. 27, s. 2015)

Earthquake Family Preparedness Questionnaire (G3 – G10)

Instruction: Each student is assigned to interview their parents, guardian/s or any adult
family member to answer the following questions.

A. Before an Earthquake (Please check appropriate box)

YES NO NOT SURE
1. Do we know the emergency numbers and contact details of police,
hospitals and barangay officials?
2. Do we all know where the nearest safe evacuation area from our
house in the event of an earthquake?
3. Do we all know the earthquake evacuation plan at our school/
workplace?
4. Do we know how to evacuate infants/ children, person with
disabilities, and/ or the elderly in our house?
5. Do all family members know the initial response during an
earthquake?
6. Are overhead shelves/ cabinets at home free of heavy objects
they may injure people?
7. Are heavy furniture, cupboards, and other heavy appliances
strapped/ bolted to the walls/ floors?
8. Do we store food and drinking water for possible earthquakes?
9. Do we all know if we are near any body of water? E.g. lake, sea,
river
10. As a result of an earthquake, do we all know if we are vulnerable
to possible tsunamis?

1 2 3 4 5
In a scale of 1-5 with 1 being the lowest and 5 being the
highest, describe your level of preparedness before an
earthquake. Kindly encircle your answer.

B. During an Earthquake
1. If the earthquake happens while travelling, what will be our initial response? (check
what is applicable, or include answers not captured)
- Stay inside the car.
- Check cellphones and communicate to authorities.
- Stop in a safe place.
- Go to a safe place.
- Stay inside the car.
- Stop the car and go to an open space.
- Calm down then step out of the car and proceed to a safer area.
- Do not panic.
- Follow safety instruction.
- Others:_____________________________________________

Division Address : DepEd Bldg., Pob. Bontoc, Mountain Province, 2616

Division Email: mt.province@deped.gov.ph
Division Website: www.depedmp.ph
Official FB Page: DepEd Tayo Mountain Province
 Republic of the Philippines
Department of Education
CORDILLERA ADMINISTRATIVE REGION
SCHOOLS DIVISION OF MOUNTAIN PROVINCE

2. If the earthquake happens while at home, what will be our initial response? (check
what is applicable, or include answers not captured)

- Go under the table.

- Apply the duck, cover and hold.
- Don’t panic. Just proceed to a safe place.
- Stay away from falling objects.
- Stay away from hazardous area and exit immediately.
- Hide in a safe place.
- Others: ______________________________________________

3. If the earthquake happens while at home, how do we proceed with the evacuation?
(check what is applicable, or include answers not captured)

- Run if needed.
- Do not panic. Bring some food, water and blanket then proceed to an open
space/ evacuation area.
- Cover your head while walking.
- If the earthquake stops, proceed as fast as you can to the evacuation area.
- Get important things and go to the evacuation area
- Go outside
- Others: ______________________________________________

4. If the earthquake happens while travelling, where do we meet? (check what is

applicable, or include answers not captured)

- Move to an open area.

- Communicate to the members of the family for the meeting place.
- Meet in a safe place.
- Go to the nearest evacuation center.
- Meeting place.
- Mountain
- Others: _________________________________________________

5. If someone in the family someone who lives with us is injured, what should be initial
response? (check what is applicable, or include answers not captured)

- Call the barangay officials.

- Apply first aid or call for medical help.
- Help the injured person.
- Contact responsible persons for first aid before sending to the hospital.
- Others: _________________________________________________

6. If we are trapped inside the house, what do we do? (check what is applicable, or
include answers not captured)

- Make a noise.
- Create sound.

Division Address : DepEd Bldg., Pob. Bontoc, Mountain Province, 2616

Division Email: mt.province@deped.gov.ph
Division Website: www.depedmp.ph
Official FB Page: DepEd Tayo Mountain Province
 Republic of the Philippines
Department of Education
CORDILLERA ADMINISTRATIVE REGION
SCHOOLS DIVISION OF MOUNTAIN PROVINCE
- Don’t panic.
- Wait for a rescue.
- Apply duck, cover and hold.
- Shout for help.
- Go to the window
- Others: ______________________________________________________

7. If the designated area is damaged, where is our alternative? (check what is

applicable, or include answers not captured)

- Plaza
- Church/ School
- Barangay hall
- Private house (House of relatives)
- Open area
- Nearest safe place
- Stay at home
- Any house
- Others: ______________________________________________________

8. If the communication is down, how long are we going to wait for each other at the
designated meeting place? (check what is applicable, or include answers not
captured)

- Short period
- 15 - 20 minutes
- 1 hour
- Until the communication will be stable
- Wait for the announcement of the BLGU or LGU
- 30 minutes
- Others: _______________________________________________________

1 2 3 4 5
In a scale of 1-5 with 1 being the lowest and 5 being
the highest, describe your level of preparedness
during an earthquake.

C. After an Earthquake and Initial Shaking (Please check appropriate box)

YES NO NOT SURE
1. Do we know the contact numbers of persons in our
household?
2. Do we know when to evacuate?
3. Do we know that we should not go back to our homes/
buildings due to possible effects of aftershocks?
4. Are we prepared for possible effects of aftershocks such as
fires, further damage to house/ building?
5. Is our home free of possible fire-triggers after an

Division Address : DepEd Bldg., Pob. Bontoc, Mountain Province, 2616

Division Email: mt.province@deped.gov.ph
Division Website: www.depedmp.ph
Official FB Page: DepEd Tayo Mountain Province
 Republic of the Philippines
Department of Education
CORDILLERA ADMINISTRATIVE REGION
SCHOOLS DIVISION OF MOUNTAIN PROVINCE
earthquake?
6. If we are vulnerable to tsunamis, do we know how to
properly evacuate?
7. Do we know how to preserve or keep food safe after an
earthquake?
8. Do we know from whom we can get accurate and credible
data/ information so as not to contribute to false rumors which
cause panic, etc?

1 2 3 4 5
In a scale of 1-5 with 1 being the lowest and 5 being the
highest, describe your level of preparedness after an
earthquake. Kindly encircle your answer.

Majority of the answers should be yes. If you answered no or not sure in any of
the above questions, you are advised to seek the assistance of local authorities
on the matter.

Parent/Guardian/Adult Family Member’s Signature:

___________________________________
Name of Parent/ Guardian/ Adult Family Member:
____________________________________

Division Address : DepEd Bldg., Pob. Bontoc, Mountain Province, 2616

Division Email: mt.province@deped.gov.ph
Division Website: www.depedmp.ph
Official FB Page: DepEd Tayo Mountain Province