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Office of Emergency Management P.O. Box 1373, Fairplay CO 80440 (719) 836-4372 fax: (719) 839-3273 EMERGENCY EVACUATION ASSISTANCE SURVEY When disasters occur, Park County residents may be required to evacuate their homes quickly to get to safety. Due to special transportation needs or medical conditions, some residents may have difficulty or may need assistance from the community. Currently, Park County does not have a system in place to be able to provide transportation to residents without a vehicle or with special needs, unless a medical emergency requires an ambulance. Therefore, the Local Emergency Planning Commission has developed an Emergency Evacuation Assistance Survey in the first step toward identifying citizens with special needs. The purpose of this survey is to determine an approximate number of citizens requiring evacuation assistance and to determine which types of assistance are most commonly needed. This form is currently for informational purposes only. It will give us the opportunity to find out how many people may need extra assistance during a disaster so that we can continue our planning process to include special transportation or medical assistance solutions. It is our hope that we will be able to expand this survey in the future to create an emergency evacuation registry that may be used by emergency responders for any emergency requiring evacuation, such as flooding, gas leaks and fires. Additionally, this will help us in looking at our designated shelters throughout the county to determine if we need to establish a special needs shelter location. If you would like to participate in this survey, please fill go to the Park County website, print the survey, fill it out and send it to: Park County Office of Emergency Management, PO Box 1373, Fairplay, CO 80440. If you have any questions or concerns, please contact Emergency Management at (719) 836-4372 or by email at Thank you in advance for your participation in this project.