A useful household check-in does not ask everyone to prove that they are calm. It asks whether the next practical support tasks have an owner, whether important information is clear, and whether the household has reached the limit of what its own plan can safely manage.
This worksheet deliberately has no score, symptom list, risk category, saved account, or recommendation engine. It cannot assess another person. It turns selected household gaps into a short action list that remains in the current browser page unless you choose to print it.
Use it as the bounded planning tool within the Mental and Emotional Preparedness hub.
Private in-browser worksheet
Household support check-in
Select only the practical items that need a household decision. This worksheet does not score distress, assess safety, diagnose a condition, or save what you enter.
Stop using this worksheet for immediate danger. Call 911 for an emergency or a person who cannot be kept safe. In the United States and territories, call or text 988 for crisis support. SAMHSA's Disaster Distress Helpline is 1-800-985-5990 by call or text for disaster-related emotional distress.
Use it only after immediate safety is addressed
Do not complete a form while fire, smoke, floodwater, violence, a medical emergency, unsafe temperature, carbon monoxide, an evacuation order, or another immediate threat requires action. Follow the authority and plan responsible for the event.
The evacuate-or-shelter framework owns movement decisions. The Medical Device and Medication Continuity plan owns clinical, equipment, medication, supplier, and relocation questions. This tool cannot override either.
Check practical support, not emotions
The selections describe household work that may need attention. They do not describe a person’s condition. A household might select caregiver handoff because one adult has worked for hours, because a schedule changed, or because a backup arrived. None of those facts produces a diagnosis.
Use observable language:
- “Nobody is assigned to check the next official update.”
- “The child does not know which adult is responsible.”
- “The caregiver says they cannot safely take the next shift.”
- “The sleep area does not have a clear exit and wake plan.”
- “We need the established outside support contact now.”
Avoid labels such as unstable, irrational, weak, dangerous, traumatized, or fine. A label does not assign a useful task and may discourage the household from seeking the right help.
Give every selected action an owner
After building the list, add a name on the printed copy or a private household note. Assign only a task the person has agreed and is able to do. Examples include checking one official source, preparing ordinary food, supervising a safe child activity, receiving a delivery, setting out battery lighting, or making an approved contact.
Do not use the worksheet to authorize medication, clinical care, medical-device operation, lifting or transfer, emergency driving, security response, child custody, or another task that requires training, consent, legal authority, or a specialist plan.
The caregiver-load guide explains how to separate essential, delegated, and deferred work. A blank owner means the task is still unresolved.
Set a real next check-in
“Later” is not a check-in. Use an observable time or event: after the 8 p.m. utility update, before the next meal, when the second caregiver arrives, after the shelter call, or at the established care-plan time. The event must be real and reachable.
At that point, ask four questions:
- Did the official instruction or physical condition change?
- Were the assigned tasks completed or handed off?
- Does any essential support now lack a capable owner?
- Does the household need emergency, crisis, clinical, building, utility, shelter, accessibility, or other qualified help?
Do not keep rescheduling a failed task when the failure itself is an escalation trigger. If essential care, safety, or movement cannot continue, use the proper outside path.
Keep the record private and temporary
The in-page tool does not intentionally store or transmit the selections. Printing creates a physical record under the household’s control. Do not enter names, diagnoses, account numbers, access codes, detailed locations, medication records, or crisis narratives in the free-text field.
If you print the list, keep it where the intended household members can use it and visitors cannot casually read private details. Destroy obsolete copies. Use the Family Communication Plan for approved contacts and the household’s protected record system for clinical or identity information.
Use the specialist guide for each gap
Each item points to a different owner:
| Selected gap | Next ReadyLience route | Boundary |
|---|---|---|
| Official information | Local emergency alerts | Current issuing authority controls |
| Household update | Difficult emergency updates | No rumors or false reassurance |
| Caregiver coverage | Caregiver load | No untrained clinical transfer |
| Sleep period | Blackout sleep planning | Temperature, medical, and fire plans control |
| Child support | Children and uncertainty | Adult responsibility remains explicit |
| Ordinary comfort | Comfort and morale supplies | Essentials come first |
| Household plan is insufficient | Emergency, crisis, clinician, provider, or local qualified service | No checklist assessment |
The check-in is useful because it routes the problem. It is not meant to become a second version of every specialist plan.
Run the check-in without forcing disclosure
One adult or household coordinator can ask whether a practical category needs attention. Nobody must explain private feelings to select food, quiet, rest, a clearer update, or outside support. Offer a way to respond privately when the household is in shared accommodation.
Do not conduct a group vote on whether someone else needs mental-health care. Do not ask children to evaluate adults. Do not promise confidentiality that cannot be maintained when immediate safety requires emergency help. Individual assessment belongs with qualified services.
A person can decline the household conversation and still receive essential safety information, food, water, access, supervision, and the opportunity to contact appropriate support.
Prepare a paper fallback
The tool uses a small amount of browser JavaScript, so keep a paper version simple. Draw seven lines: safety, official update, caregiver handoff, rest, children, ordinary maintenance, outside support. Circle only the lines that need action, name the owner, and add the next check-in.
The paper fallback is intentionally less detailed than a clinical form. Do not add symptom scoring, a personality judgment, or a homemade crisis algorithm. Store emergency and qualified-support numbers separately where the household can access them.
Review the process on a quiet day
Use the tool for an ordinary planned outage or severe-weather preparation window. Check whether every household member can read or hear it, whether the labels make sense, and whether the responsible contacts are current. Reset the page afterward.
Do not simulate violence, self-harm, injury, panic, disappearance, or a medical emergency. A useful practice reveals a missing role, inaccessible format, unclear check time, or outdated contact without manufacturing distress.
Revisit the plan after a move, new child, caregiver change, disability or communication change, new medical device, separation, loss of a support person, or a previous event that exposed a gap.
Know the stop rule
Stop using the worksheet and call 911 for immediate danger, violence, fire, medical emergency, or a person who cannot be kept safe. In the United States and territories, call or text 988 for suicide, mental-health, or substance-use crisis support. Call or text SAMHSA’s Disaster Distress Helpline at 1-800-985-5990 for disaster-related emotional distress.
Qualified support should not depend on a worksheet score, because there is no score. The household’s job is to notice when its practical plan is not enough, preserve immediate safety and privacy, and connect with the appropriate service.
Sources reviewed
- Substance Abuse and Mental Health Services Administration: Disaster Distress Helpline
- Centers for Disease Control and Prevention: disaster coping and helping children cope
Sources reviewed July 15, 2026. This non-scoring household worksheet is not a screening instrument, risk assessment, diagnosis, treatment plan, crisis service, or substitute for qualified care.