EMERGENCY AND DISASTER PREPAREDNESS QUESTIONNAIRE

Dear Employee,

Emergency and disaster preparedness is very important especially in an institution to

help lessen the impact of disasters or emergencies and to design a coordinated plan that
reduces the waste of resources, time and efforts.
Knowing that you have recently undergone a special training on this matter, may we
therefore take some time to evaluate your learning, gauge your knowledge and preparation in
cases of emergency or disaster.

Please answer the following questions.

I. IDENTIFICATION. Write the answer on the space provided after each item.

1. Write the meaning of the acronym HEMS.

________________________________________________________________________________________

2. This refers to a situation which poses a level of threat to life, health, property or
environment that can become active and calls for an emergency response.
_________________________________________________________________________________________

3. This refers to a sudden, calamitous event that seriously disrupts the functioning of a
community or society and causes human, material, and economic or environmental losses.
________________________________________________________________________________________

4. This is the “code” that is activated when a fire breaks out in St. Paul Hospital.
________________________________________________________________________________________

5. This is the first thing one needs to do when using a fire extinguisher.
________________________________________________________________________________________

II. TRUE OR FALSE: Write TRUE if the statement is factual, and write FALSE if it is not.

_____________ 1. Risk is a situation which poses a level of threat to life, health, property or
environment.
_____________ 2. The safest area to evacuate patients and staff during a fire is in the hospital
Multipurpose Hall.
_____________ 3. The correct method of using the fire extinguisher is PASS which means pull
the pin, aim at the base of the fire, squeeze the nozzle and sweep side to
side.
_____________ 4. The patients who are critically ill or bed ridden should be the first priority in
evacuation.
_____________ 5. The Code Alert System is used in St. Paul Hospital to determine the patients
who should be prioritized to receive treatment during emergencies.
_____________ 6. The St. Paul Hospital employee or staff who discovers a fire should be the
first to report the incident.
_____________ 7. In case a fire breaks out in St. Paul Hospital, the priority patients to be
evacuated are those in the emergency room.
_____________ 8. One of the main tasks of the Rescue and Evacuation Team of St. Paul
Hospital is to prioritize which area or department needs to be evacuated.
_____________ 9. It is safe to use the elevator in cases of fire or an earthquake since it is a
faster way out.
____________10. The First Aid Team of St. Paul Hospital is responsible to report an incident to
the necessary authorities such as the BFP, DOH and/or PNP.
III. MATCHING TYPE: Match the Code Alert System used in St. Paul Hospital in Column B to
the corresponding the situations in Column A. Write the letter of the answer on the spaces
provided below.

Emergency Situations/Conditions Code Alert System

1. Fire or smoke A. Brown
2. Medical emergencies B. Blue
3. Forecast typhoons (signal #2 and above) C. White
4. External emergencies D. Purple
5. Bomb threat E. Red

1. 2. 3. 4. 5.