EARTHQUAKE AWARENESS AND
PREPAREDNESS QUESTIONNAIRE
Part I — Basic Information
Name: ________________________________________
Age: _________
Sex: [ ] Male [ ] Female
Grade/Year Level: ________________________________________
Section: ________________________________________
Part II — Earthquake Awareness
Please put a check (✔) in the box that best represents your answer.
Statement Strongly Agree Neutral Disagree Strongly
Agree Disagree
I understand [] [] [] [] []
what an
earthquake
is and how it
occurs.
I am aware [] [] [] [] []
of the risks
and dangers
earthquakes
may cause.
I know the [] [] [] [] []
early
warning
signs of
earthquakes.
I am familiar [] [] [] [] []
with
earthquake
drills
conducted in
school.
I know what [] [] [] [] []
to do during
and after an
earthquake.
Part III — Earthquake Preparedness
Please put a check (✔) in the box that best represents your answer.
Statement Strongly Agree Neutral Disagree Strongly
Agree Disagree
I know the [] [] [] [] []
safest places
to stay
during an
earthquake.
I know the [] [] [] [] []
evacuation
routes in my
school/com
munity.
I have [] [] [] [] []
participated
in
earthquake
drills.
I know how [] [] [] [] []
to assist
others
during an
earthquake.
I have [] [] [] [] []
prepared an
emergency
kit at home.
Additional Preparedness Checklist (check all that apply):
[ ] I have stored food and water supplies for emergencies.
[ ] I know emergency hotline numbers.
[ ] My family has a meeting place after an earthquake.
[ ] I have received training on disaster response.
Part IV — Open-ended Question
What are your suggestions to improve earthquake preparedness in your
school/community?
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