Large Organization Multi-Site Questionnaire

Name of Organization:
Address:
Authorized Representative of Organization:
Phone:
Fax:
E-Mail:
Are you a service or product based organization?	Please Select One Service Product Both
Please indicate what best describes your organization:	Please Select One Insurance Company, Bank or Credit Union School, College, University or Technical Institution Airline, Bus Company or Mass Transportation System Maritime Port or Cruise Line Hotel, Casino, Resort or Resort Community Privately Owned / Public Venues (Stadium, Arena, Zoo, Museum, etc.) Multi Site Manufacturing / Distribution Organization Hospital, Residential Short and/or Long Term Health Care Facility Commercial Real Estate Owner Facility/Property Management School, College, University and/or Technical Institution First Response Entity Disaster/Emergency Relief Aid Organization (NGO's) Post Disaster/Emergency Recovery Entity Corporation Small to Medium Business Enterprise Manufacturing and/or Industrial Entity Manufactured Home Community Managed Senior Home Community and/or Apartment Complex Nursing Home, Assisted Living and/or Day Care Facility Other
If selecting Other, please describe:
Number of individuals at the organization’s main or corporate offices:
Average number of individuals at any remote location (unit) that would be part of the Disaster/Emergency Management and Business Continuity Program
Number of locations/units affected by your operations i.e. terminals, regional offices, hubs, etc.:
Please provide a brief description of the locations/units above i.e. 2 hubs – 1 Atlanta, 1 O’Hare. Regional offices in Los Angeles, New York and London, etc
Are any locations/units in a high risk natural disaster prone area i.e. hurricane, tornado, earthquake, landslide, floodplain, etc. (If so, please describe):
For the main or corporate offices; list any operations in the nearby area that could affect your operations in the event of a disaster i.e. chemical processing facility, petrochemical storage facility, manufacturing operations, rail yards, airports, etc.
Please define the scope covered by your organizational plan or registration i.e. terminal operations and hubs in U.S. only. Offices on East and West coast only. All Florida operations. Operations in U.S. Canada and Europe. etc.:
Does your Organization operate with an existing Disaster Recovery Plan (IT/Data centric, vital records, off-site storage etc.)?	Please Select One Yes No
Is your Organization currently prepared by having and maintaining a fully comprehensive “All Hazards” Disaster/Emergency and Business Continuity Plan and/or Program?	Please Select One Yes No
Do you feel this plan and/or program meets the requirements of NFPA 1600?	Please Select One N/A Yes No
Does your Organization maintain a budget dedicated to emergency preparedness, response, recovery and resumption?	Please Select One Yes No
Does your Organization have a supply chain (i.e. parts, distributors and/or other service providers) that affect your ability to operate?	Please Select One Yes No
Do your suppliers have and maintain a Disaster/Emergency and Business Continuity Plan and/or Program?	Please Select One Yes No
Do your suppliers operate in a natural disaster prone area i.e. hurricane, tornado, earthquake, landslide, floodplain, etc?	Please Select One Yes No
Do your suppliers operate in a pandemic or terrorist prone area?	Please Select One Yes No
Have your suppliers established Contingency/Aid agreements to continue uninterrupted in supplying your Organization with product and/or services?	Please Select One Yes No
Does your Organization operate with an existing Quality or Environmental Management System (i.e. ISO 9001:2000, ISO 14001 etc)?	Please Select One Yes No
Does your Organization currently undergo other compliance auditing (i.e. Sarbanes-Oxley, regulatory or other)?	Please Select One Yes No
Have you had an on-site visit by any oversight/regulatory authority (OSHA, EPA, DEQ, etc.) in the past 3 years; include a brief description (i.e. 2004 OSHA accident investigation)?	Please Select One Yes No
Visit Details
Is your Organization willing to commit to a Stage 1 on site readiness review conducted by NEMR. This is considered a contractual agreement to allow NEMR to conduct an on site visit and assess your organizations level of readiness for a complete audit to the requirements of NFPA 1600.	Please Select One Yes No
Is your Organization willing to commit to a desktop assessment (review) of your emergency preparedness and business continuity program documentation i.e. manuals, procedures, instructions, etc.	Please Select One Yes No