| Download the PDF version of the Important People and Places Checklist |
| Important People and Places (PDF file) |
| To print in booklet format, download this version: Important People and Places (PDF file) |
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What is the Important People and Papers Checklist? The Important People and Papers Checklist will help you organize your emergency contact information. To complete the checklist, either print this Web page or download the PDF version of the checklist (see orange box to the right of the screen for how to download the PDF version).
Contents of this page:
The purposes of the "Important People and Papers" checklist are to organize contact information so you can reach your support network and other important contacts, and to organize copies of important papers that you may need in an emergency.
In an emergency, don't count that regular communication will work. Electricity may be out, phones, including cell phones, and wireless devices may not work. Plan how your support network partners will contact you in an emergency if the telephone does not work.
Contact your support network partners regularly to confirm their readiness to check wit you in an emergency and their ability to come to your aid if needed. If you arranged for transportation in an emergency, check in every couple of months with your transportation contact person to make sure that your plan will still work.
Review your contacts and papers every couple months to make sure the information is still current.
Build a personal support network of people who have agreed to check with you in an emergency and help you if needed.
Local phones may not work during an emergency. It may be easier to call a support network person long distance than to call someone within your area. The long distance person can serve as the point of contact.
| Completed? | Checklist item |
|---|---|
| Yes / No | If possible, have more than one support person in case your designated person is not able to help you. |
| Yes / No | If you decide to, give keys to your support network partners. |
| Yes / No | Tell your support network partners where you keep emergency supplies. |
| Yes / No | If you decide to, give copies of your plan, copies of important papers, emergency plans, and written instructions to your support network partners. |
| Yes / No | Plan how your support network partners will contact you in an emergency if the telephone does not work. |
| Yes / No | Contact your support network partners regularly to confirm their ability to check with you in an emergency and to come to your aide if needed. |
| Yes / No | Identify a relative or friend - someone who lives about 100 miles away - to be your out-of-town contact person during an emergency. |
| Yes / No | Instruct your support network partners to try to call your out-of-town contact person to report your condition and your location. |
| Yes / No | Make a list of your support network partners, your out-of-town contact person, local service providers and emergency response agencies. |
During and after an emergency the 911 system may be overwhelmed with calls or out of service entirely. Make a list of direct-dial telephone numbers, cell phone numbers, e-mail addresses, and any alternate methods of contact. The following are the people and places you should include on your contact list.
During and after an emergency you will need important documents. Keep copies of your important documents in this folder, together with you emergency contacts. Store your original documents in another place, one that is waterproof and fireproof if possible.
Prepare an Emergency Health Information Card (PDF file) to carry with you at all times. Keep a copy with your important papers. Your card should list your name, address, phone number, medications, equipment, allergies and sensitivities, sensory and communication limitations, treatment wishes, case manager, service coordinator or other providers, their names and telephone numbers, your family, contact people, and support network partners. Carry the card with you at all times.
| Completed? | Checklist item |
|---|---|
| Yes / No | Emergency Health Information Card |
| Yes / No | license, state identification or passport |
| Yes / No | recent photo, if you have no license, state identification or passport |
| Yes / No | birth certificate |
| Yes / No | Social Security card |
| Yes / No | food stamps card or eligibility letter |
| Yes / No | extra copies of medication prescriptions |
| Yes / No | Social Security benefits (SSI or SSDI) eligibility letter |
| Yes / No | private health insurance, Medicaid and Medicare cards |
| Yes / No | power of attorney, health care power of attorney, living will forms |
| Yes / No | written instructions to turn off your utilities |
| Yes / No | written instructions for your personal care, transport, and medical equipment |
Have you completed the other two checklists? If not, here are the links to the other two checklists:
If you have completed all three checklists, you are done!