Medical equipment outage worksheet

Who this is for

People who use an oxygen concentrator, CPAP or BiPAP machine, ventilator, suction machine, nebulizer, home dialysis, infusion or feeding pump, power wheelchair, powered bed or lift, or refrigerated medicine such as insulin. It is also for family members, caregivers and neighbors who help. The full explanation is in A power outage plan for a household that uses medical equipment.

How to use it

1. Print one copy of Part 2 for each device. The U.S. Food and Drug Administration (FDA) suggests a separate plan for each device.
2. Ask the device maker, equipment supplier or clinician the questions in Part 2, and write down their answers and the date you asked.
3. Fill in the other parts together with everyone who might help.
4. Keep the worksheet with the equipment, and give a copy to your check-in person.
5. Update it whenever equipment, medicines, clinicians, helpers or phone numbers change, and look it over before wildfire or storm season.

This page is for your own use. Keep it private, and do not post it online. Your clinician, pharmacist and equipment supplier decide what is right for your equipment and medicines; this sheet only records their answers.

Part 1: Contacts

Part 2: One device (copy this part for each device)

Device: ______________________ Model: ______________ Maker's phone: ______________

Battery tried on (with supplier's OK, while power was on): __________ It ran for: __________

People who know how to run this device and its backup: ______________________________

Part 3: Medicines that must stay cold

Fill in from the label or the pharmacist. Do not guess.

Cooler, ice or gel packs and refrigerator thermometer are kept: ______________________

For insulin, also note: never let it freeze; do not use insulin that has frozen; insulin in a pump that gets hotter than 98.6°F should be thrown away (FDA).

Part 4: Backup power and safety checklist

• Each backup battery is charged. Date last checked: __________
• Generator spot chosen outdoors, at least 20 feet from doors, windows and vents, never in a garage, basement, crawlspace, shed or on a porch.
• Generator is not wired into the house unless a professional installer did it and the city or county building department inspected it; extension cords are the right size.
• Fuel is stored outside the house.
• Battery-powered or battery-backup carbon monoxide alarms near sleeping areas and on every floor; test button pressed monthly. Date replaced: __________
• Flashlights and spare batteries; no candles or gas lanterns if oxygen is used.
• A way to charge phones without wall power.
• We know how to open the garage and any electric doors by hand.
• Copies of the medicine list and prescriptions are with this worksheet.

Part 5: Who we have told, and which alerts we get

• Utility told that someone at home uses powered medical equipment. Date: __________
• Utility medical or vulnerable-customer program applied for, if available (in California, for PG&E customers: Medical Baseline or Self-Identified Vulnerable status). Date: __________ Renewal due: __________
• Contact details and alert preferences on the utility account are current.
• Shutoff alerts set up for a relative's or other important address (PG&E calls these Address Alerts).
• County emergency alerts signed up for (in California, through CalAlerts.org).
• Asked the fire department or county emergency office whether it keeps a voluntary list. Their answer: ______________________
• Check-in person agrees to call or visit during outages.

Part 6: When we leave, and where we go

We leave home for a place with power when (for example, "when the last backup tank or battery starts"): ______________________________

We call 911 when (fill in with your clinician): ______________________________

Take with us: the device and its chargers, backup batteries, supplies for at least 3 days, refrigerated medicine in the cooler, the medicine list, insurance cards and this worksheet.

Part 7: When the power comes back

• Checked for water before plugging anything in; no wet cords or devices plugged in.
• Checked device settings (some devices reset to defaults).
• Checked supplies; set aside any with torn packaging, or that got wet, too hot or too cold.
• Checked refrigerated medicine against the label, and called the pharmacist about anything uncertain.
• Recharged batteries, asked for oxygen refills and restocked supplies.
• Wrote down what went wrong, and updated this worksheet.

Limits of this worksheet

• It is a planning record, not medical advice, a triage tool or a live alert. Answers about devices and medicines must come from the maker, supplier, clinician or pharmacist.
• Utility programs, eligibility and alert practices change, and none of them keeps power on during a shutoff. Check the program's own page.
• Local emergency services differ. A voluntary list, where one exists, does not mean someone will come; plan to manage without it.

Sources

1. Home Use Devices: How to Prepare for and Handle Power Outages for Medical Devices that Require Electricity — U.S. Food and Drug Administration, booklet (PDF), accessed October 26, 2026.
2. FDA Offers Tips about Medical Devices and Natural Disasters — U.S. Food and Drug Administration, content current as of April 16, 2024.
3. Information Regarding Insulin Storage and Switching Between Products in an Emergency — U.S. Food and Drug Administration, content current as of September 28, 2026.
4. About Carbon Monoxide Poisoning — Centers for Disease Control and Prevention, January 12, 2026.
5. What to Know About Generators and Carbon Monoxide — U.S. Consumer Product Safety Commission, March 2022.
6. How to Prepare for an Emergency or Disaster When You Have Lung Disease or a Sleep Disorder — American Thoracic Society, 2016 (online version updated April 2021).
7. Medical Devices: Emergency Planning Tips and Public Safety Power Shutoffs — Pacific Gas and Electric Company, accessed October 26, 2026.
8. Backup power and safety — Pacific Gas and Electric Company, accessed October 26, 2026.
9. How To Sign Up For Alerts In Your County — California Governor's Office of Emergency Services, accessed October 26, 2026.