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RPV Community Action Network (RPV CAN) Survey

  1. RANCHO PALOS VERDES COMMUNITY ACTION NETWORK 
    (RPV CAN) SURVEY

    As part of the City of Rancho Palos Verdes’ emergency preparedness planning efforts, the City seeks to collect information from its residents in advance of an emergency. Rancho Palos Verdes residents are encouraged to complete this survey and join the RPV Community Action Network (RPV CAN). RPV CAN is a framework to connect neighborhoods with emergency information, encourage neighborhood preparedness, and establish a communication chain of command between residents and the City in the event of a major emergency. 

    Information will be kept confidential and maintained as a database by the City. Please note that the City cannot guarantee that participants in the RPV CAN program will be contacted through the network. First responders use a variety of methods to communicate and implement emergency protocols; always follow their directions. Please direct questions to Administrative Analyst McKenzie Bright at mbright@rpvca.gov or 310-544-5305.

  2. CONTACT INFORMATION:

  3. EMERGENCY CONTACT INFORMATION:

  4. PERSONAL PREFERENCES

    This section will assist the City's emergency planning efforts.

  5. Living Situation (select one)
  6. Do you have pets?
  7. Preferred method of communication (select all that apply)
  8. Primary method of transportation (select all that apply)
  9. Do you need assistance to get out of your house?
  10. Do you use any mobility assistance devices (e.g., cane, wheelchair, etc.)?
  11. If you are medically dependent on electricity, have you signed up for Southern California Edison’s Medical Baseline Allowance Program?
  12. Do you have a three-day emergency kit prepared?

    (See https://www.ready.gov/kit for how to build a kit) 

  13. VOLUNTEER TO BE A NEIGHBORHOOD REPRESENTATIVE

    RPV CAN relies on neighborhood volunteers, known as Neighborhood Representatives, to help communicate emergency preparedness information from the City to their neighbors. All training will be provided and no prior experience is necessary. Additional information on RPV CAN and becoming a Neighborhood Representative is available at rpvca.gov/CAN

  14. Would you like to volunteer to be a Neighborhood Representative?
  15. Can the information you have provided in this survey be shared with your Neighborhood Representative? *
  16. Leave This Blank:

  17. This field is not part of the form submission.