Initial Damage Assessment (Events Other than Flood)

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Immediately following a disaster or major emergency it is necessary to quickly, and as accurately as possible, assess the damages and impacts to the community. The initial damage assessment focuses on damages to residences, businesses and public infrastructure.

A timely damage assessment will give important information to emergency managers to enable them to support emergency response personnel and provide resources to the areas most in need and effectively assist the population with critical recovery following the incident.

This is NOT an application for federal disaster assistance.

The public can use this form as a means of reporting their damage to local emergency officials. THANK YOU

1 - Address Number *

2A - Street Name/Apartment Number *

2B - City/Town *

3 - Indicate Type of Dwelling: *

Indicate if damaged dwelling is: SF=Single Family Home, MF=Multi Family Struture (Apartment Bldg, Duplex, 2-flat, etc.), MH=Mobile Home, B=Business

4 - Rent / Own *

Indicate if the occupant owns or rents the dwelling.

Own

Rent

UNK

5 - Is your dwelling Habitable Without Repairs? *

Minimal damage to structure and occupant can live in the dwelling without making repairs.

Yes

6 - Is your dwelling Habitable with FEW repairs? *

Structure is damaged and uninhabitable but may be made habitable in less than 30 days.

Yes

7 - Uninhabitable / needs extensive repairs. *

Substantial roofing elementss damaged or missing, damaged windows, doors, exterior walls, interior wind damage. Mobile home pushed off foundation.

Yes

8 - Total loss / not feasible to repair.

Only foundation remains, two or more walls destroyed and roof substantially damaged or destroyed

Yes

Clear selection

9 - Insurance *

N=No insurance, H=Homeowners insurance, R= Renters insurance, UNK=unknown

UNK

10 - Comments

If #7 or #8 is marked YES, briefly describe the damage here. Examples of brief descriptions are: basement wall collapsed, home/mobile home off foundation, large foundation cracks.

11 - Name of person completing assessment: *

12 - Email Address: *

13 - Telephone Number: *

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