Chester County Government Forms

2. Name*
4. The safe evacuation zone for 4 Jones is:*
   -- Select One --Front parking lot, street light #2Zone 1Gazebo outside 1 WestTennis Courts
6. True or False? Pocopson home may accept residents from other facilities who are being relocated because of a disaster.*
   -- Select One --TrueFalse
8. True or False? If you receive a bomb threat by telephone, you should call 9-1-1 immediately.*
   -- Select One --TrueFalse
10. True or False? If an active shooter is threatening you and you can’t get away, you should hide.*
    -- Select One --TrueFalse
12. True or False? If Pocopson Staff are exposed to a chemical threat, they should expect to get medicine from their family physician.*
    -- Select One --TrueFalse
14. In the event of high winds or a tornado warning, you should:*
    -- Select One --Place furniture in front of windowsHide in the basementTake shelter in the cafeteriaRemove residents away from doors and windows
16. True or False? Failure of the air conditioning system in the summer is not an environmental emergency.*
    -- Select One --TrueFalse
18. True or False? Pocopson is required to keep a set amount of food and water on hand in case we have to shelter in place.*
    -- Select One --TrueFalse
20. Code Yellow refers to:*
    -- Select One --Residents who fight with other residentsResidents who have no living relativesResidents who have wandered away from their unit or the facility without permissionResidents who have the flu
22. True or false? If a resident goes missing from the unit, you should call 9-1-1.*
    -- Select One --TrueFalse
24. True or false? It’s not my job to know where the fire extinguishers are or how to use them.*
    -- Select One --TrueFalse
26. True or false? Training is one of the ways you prepare for an emergency.*
    -- Select One --TrueFalse
28. True or false? Incident Commander, Planning Officer, and the Commissioners are in charge of the scene in an Emergency/Disaster situation at Pocopson Home.*
    -- Select One --TrueFalse
30. If there is a fire on the unit, who is in charge of the scene until the Fire Marshall arrives?*
    -- Select One --Director of NursingPocopson AdministratorNursing SupervisorSecurity
32. If you smell smoke or see a fire, you should: *
    -- Select One --Yell “Code Red” and announce the location of the smoke/firePull the alarm closest to youClear the hallwayAll of the above
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