Who has the key

Name the people who can reach this house and help the person who needs help. A utility list is a request, not a promise that the power stays on. Leave a row blank when it does not apply.

The support people

Who has a key

Phone

Where the supplies are

Who can give a medicine

Who can run a device

Neighbor to check

Someone gives a medicine, or runs a device, only after a clinician has shown them how. This sheet does not teach that skill.

If care is usually at a clinic

Usual clinic

Backup clinic

That clinic’s plan

Lists that are not a guarantee

Utility list requested

Date asked

Fire department told

Date told

Local registry, yes or no

Ask the power company about a priority restoration list only if someone here uses electric medical equipment. Being on that list does not mean the power will stay on. Tell the fire department about a life-support device. A city or county registry, where one exists, is voluntary. The Ready.gov page does not say a registry guarantees rescue.

Fiction. Not your house.

In the apartment sample, one trusted person has a key and knows the supplies are in the hall closet. This page does not name that person. No life-support device is stated. If this household later asks to be on a utility list, the list is still not a promise of power.

Sources checked for this draft: Ready.gov Older Adults, 26 March 2026; Ready.gov People with Disabilities, 9 September 2026; ADA National Network emergency power planning checklist, 2018. This sheet is not medical advice. In a life-threatening emergency, call 911. This file is not on sale.