Annex 14: Sample Household Urban Risk Questionnaire ■ 219
Natural disaster
Monthly
Yearly
Cause (i.e., recurring or manmade)
Drought Dust storm Earthquake Flash flood Landslide/debris flow Extreme temperature Storm surge Wildfire Household fire Wind storm Winter storm River flood Tsunami Other _____________
4. What was the impact of the disasters on you or your family? ® Lost income ® Housing damage ® Amount _______ ® Cost of repairs ______ ® Injury or death ® Disrupted services (water, electricity) 5. Following a disaster, who assists you in recovering? (For example, community association, local government, neighbors, or nongovernmental organization.)
6. Have you ever received information about how to make your family and home safer from natural disasters?
® Yes ® No (If NO, skip to Question 4)
a. If YES, how recently?
® Within the last 6 months ® Between 2 and 5 years ® Between 6 and 12 months ® 5 years or more ® Between 1 and 2 years