The City of Rolling Hills, CA - Home PageBench and water

Go To Search
Survey of Resident Resources for Emergency Preparedness

Leave This Blank:

PLEASE COMPLETE THE SURVEY BELOW. Your answers to the following questions will provide the City of Rolling Hills with important data and a list of resources in the event of a City emergency. The information collected will be provided to City authorized emergency response workers and Block Captains in preparation for and for implementation of a disaster response. With the information, officials will have knowledge of resident’s skills, equipment, and special circumstances for an effective emergency response.

Please provide the information below for all residents living at your address.

After completing the survey and clicking on "submit" below, you will be connected to the City of Rolling Hills Emergency Notification System for the purpose of inputting emergency contact information. The emergency contact information will be used to contact you in a public safety emergency.

If you already completed this survey and would like to update your contact information for the Rolling Hills emergency notification system, please click on the following link:

General Information

This information is being completed by:

1. Are there small children at your home? (If no, skip to question #4)

2. Do the children have instructions on what to do following a disaster situation?

3. Is your regular child care prepared to care for the children under emergency circumstances (medical release papers, etc.)?

4. Are any individuals at your home disabled (hearing, sight problems, etc.)? Does anyone require regular assistance due to specific medical conditions?

6. Is a member of your household non-English speaking?

7. How many pets do you have on your property?
8. Is there a member of the household who is in Active Military Reserve?

9. Would rescuers have a difficult time entering or exiting your property?

Resident Skills

Resident Equipment and Resources Available


Personal Preparedness and Checklist

Reminder: Don't forget to include your prescribed medications in your Personal Preparedness Kit!


* indicates required fields.

City of Rolling Hills
2 Portuguese Bend Road
Rolling Hills, CA 90274
Ph. (310) 377-1521
Fax (310) 377-7288
7:30 am - 5:00 pm Mon-Fri
Home  |  Email Page  |  Print Page  |  RSS  |  Accessibility  |  Copyright Notices  |  Disclaimer