USDA Forest Service OMB 0596-NEW (Expiration xx/2010)
Homeowner Risk Reduction Behaviors Concerning Wildfire Risks
Month 200X
Please answer the following questions by circling the number that best fits with how you feel.
How vulnerable do you feel about the possibility of a wildfire physically affecting you or your family:
1 2 3 4 5 6 7
not at all extremely
vulnerable vulnerable
How vulnerable do you feel about the possibility of a wildfire affecting your property and/or possessions:
1 2 3 4 5 6 7
not at all extremely
vulnerable vulnerable
What is the perceived likelihood of fire happening near your home within the next couple of years:
0 1 2 3 4 5 6 7 8 9 10
No probably 50-50 probably certain
chance will not chance will to
happen happen happen
On a scale of 0 to 10, how severe will the impact of a wildfire be where you live:
0 1 2 3 4 5 6 7 8 9 10
no harm extremely
at all devastating
Check the answer that best fits with what you have done on your property. If you will not do one or more of these actions, please provide a short explanation of why in the space provided (for example, costs too much, won’t do any good, etc.).
What is the likelihood of doing the following actions to your property:
Creating a minimum 30-foot defensible space around your home:
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not?
Putting a fire resistant roof on your home
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not?
What is the likelihood of doing the following actions to your property?
Removing any dead branches from your home’s roof and around the chimney
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not?)__________________________________________
Making sure that your home is easily identifiable and accessible from a main road
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not? __________________________________________
Making sure that all the trees on or near your property are planted away from structures
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not? __________________________________________
Stacking firewood and scrap wood piles at least 30 feet from any structure
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not? __________________________________________
Contacting your local fire department to get a personal fire safety inspection at your home and property
_____ Already done
_____ Will do in next month
_____ Will do in next 3-6 months
_____ Will do next year
_____ Probably will not do (Why not? __________________________________________
How confident do you feel in your ability to protect your property and yourself from the risk of wildfire:
1 2 3 4 5 6 7
not at all very
confident confident
What would you say is the biggest impediment to taking some action to protect your property from the impact of wildfire? Please specify:
Please circle the number that indicates the effectiveness of these actions at reducing the risk of fire.
How effective are the following actions at helping to reduce the risk of fire impacting your property and lives:
ACTION |
Not at all effective Very effective |
||||||
Creating a minimum 30-foot defensible space around your home: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Putting a fire resistant roof on your home:
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Removing any dead branches from your home’s roof and around the chimney: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Making sure that your home is easily identifiable and accessible from a main road: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Making sure that all the trees on or near your property are planted away from structures: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Stacking firewood and scrap wood piles at least 30 feet from any structure: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Contacting the local fire department to get a fire safety inspection at your home & property: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
By doing any of the above actions on your property, how effective can you be at preventing wildfires from impacting your personal property and your life:
1 2 3 4 5 6 7
not at all very
effective effective
We are interested in the extent of your experience with issues related to wildfires:
10) What type of experience have you had with catastrophic wildfire: Check all that apply.
_____ My house and/or structures on my property were destroyed (partially or totally)
_____ There have been fires very near my property (less than 5 miles)
_____ There have been fires 5 to 50 miles from my property
_____ There have been fires 51 to 100 miles from my property
_____ I\we have been evacuated from my\our house because of the threat of a catastrophic fire.
_____ Other. Please explain: ____________________________________________________
11) How well informed do you consider yourself to be about wildfire and wildfire risks:
1 2 3 4 5 6 7
Not at very
all informed informed
12) To what extent do you find information about wildfires to be personally relevant:
1 2 3 4 5 6 7
Not at very
all relevant relevant
13) I am motivated to learn more about the connection between wildfire risks and undertaking the actions stated above to create defensible property:
1 2 3 4 5 6 7
Not at very
all motivated motivated
14) Have you received any information about wildfire risks from the following sources in the last year? Please check each source that has provided you wildfire information. Also, how helpful is this information in preparing your property to be defensible? Please rate each source of information that you received on how helpful it was using the following scale:
1 2 3 4 5 6 7
Not at all very
helpful helpful
Information Source Degree of helpfulness
U.S.D.A. Forest Service (e.g. Firewise
Community info, educational brochures) ______
_____ County/City Fire Department ______
_____ Local and State Law Enforcement ______
_____ Media reports, including TV, newspaper, radio ______
_____ Neighbors and/or friends ______
_____ Environmental Organizations ______
_____ Other (please specify_________________) ______
We are interested in your experiences with the following organizations and individuals. How credible are these organizations from your perspective? Please rate each entity that is relevant to you using the following scale:
1 2 3 4 5 6 7
not at all very
credible credible
Social Entities Degree of Credibility
U.S.D.A. Forest Service ______
U.S.D.I. National Park Service ______
County/City Fire Department Individuals ______
State Forestry Office ______
Neighbors and/or friends ______
Research Reports ______
Environmental Organizations ______
Media Reports, including TV, newspaper, radio ______
Other (please specify__________________) ______
16) How responsible should YOU be for protecting yourself and your property from the impact of wildfire:
1 2 3 4 5 6 7
Not at very
All responsible responsible
17) How responsible should your homeowners’ association be for protecting you and your property from the impact of wildfire:
1 2 3 4 5 6 7
Not at very
All responsible responsible
18) How responsible should the US Forest Service be for protecting you and your property from the impact of wildfire:
1 2 3 4 5 6 7
Not at very
All responsible responsible
19) Consider a scenario in which you have undertaken and finished considerable defensible space work around your home and property. If your neighbors do not do any defensible space work around their homes, how vulnerable do you feel about a wildfire affecting your property and home.
1 2 3 4 5 6 7
Not at very
Vulnerable vulnerable
Below is a picture and description of the fire danger ratings used by the USDA Forest Service to describe the degree of fire risk in a particular area. We are interested in knowing what you believe is the risk of fire happening near your home within the next couple of years.
Please draw an arrow from the center of the picture to the level of fire danger that represents your belief about the risk of fire happening near your home within the next couple years:
start here
21) Two of the primary techniques used for active fire management in forests are prescribed fires (controlled burns) and mechanical removal (logging). Please rate each method based on how you feel about the use of each and the no active fire management option:
Prescribed fires:
1 2 3 4 5 6 7
Least preferable Most preferable
Mechanical removal or logging:
1 2 3 4 5 6 7
Least preferable Most preferable
No active fire management:
1 2 3 4 5 6 7
Least preferable Most preferable
For the following questions, please check the appropriate category or fill in the appropriate information.
Please identify your age group:
18-25________ 45-54 ________
26-34 ________ 55-64 ________
35-44 ________ 65 and over ___
Please identify your gender: _____ Male _____ Female
What is your highest level of education completed:
Some high school ______ High School _______
Some college ______ College degree _______
Postgraduate work _____ Graduate degree ______
Other (please specify ______________________________)
How long have you had a home in this area? years
How many months per year do you live in this home? _______ # of months
Please check the category which best fits your household income level per year:
Less than $15,000 ______ $35,000 - $49,999 _____
$15,000 - $24,999 ______ $50,000 – 74,999 _____
$25,000 - $34,999 ______ $75,000 – over _____
7. How close is your home to the closest National Forest or Grassland?
______ less than 1 mile ______ 21 to 50 miles
______ 1 to 10 miles ______ more than 50 miles
______ 11 to 20 miles ______ Other (please specify_________________)
8. Please identify the zip code for your primary residence: ________________
THANK YOU FOR YOUR PARTICIPATION!
Burden and Non-Discrimination Statements
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-NEW. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
File Type | application/msword |
File Title | Level of fear arousal: |
Author | Ingrid Martin |
Last Modified By | FSDefaultUser |
File Modified | 2006-11-03 |
File Created | 2006-09-13 |