Private • Printable • No account

Solo Emergency Check-In Card

Give a trusted person clear instructions for checking on you during an outage, storm, evacuation, or other disruption—without sending your information to SWC.

Your information stays on this page.Nothing you type is autosaved, submitted, or sent to SWC or analytics. Print or save your card before closing the page.

Solo Emergency Check-In CardSurviving What’s ComingPreparedness. Not panic.

About me

How to identify and reach me

My nameMy phone numberMy address or apartmentMy preferred way to communicate

My support network

Who checks on me

Nearby contact nameNearby contact phoneOut-of-area contact nameOut-of-area contact phoneWhen or why I will check inIf I do not check in, take these steps in this order

Daily needs

What a trusted helper should know

Where my current medication list is keptAllergies, communication, mobility, medical-device, or backup-power needs I choose to share

Leaving safely

Evacuation and pet plan

Primary destinationTransportation or driverPet or service-animal plan, carrier location, and backup helperLocations of my emergency kit, evacuation bag, keys, safe exit, and essential records

Immediate danger, serious symptoms, fire, or suspected carbon monoxide?Call 911. During an active emergency, follow local officials and appropriate authorities.