Damage assessment

Reporter

Name
Current available phone

Property

Type of property damaged








Street
 
City
 
State
 
Postal Code
 
Location Information
Latitude (decimal degrees N)
Longitude (decimal degrees E)
County
Displaced status
Special needs
Rented status

Damage

Type of damage





Insurance

Present incident
Homeowner's insurance
Sewer backup insurance
Floodplain
Flood insurance

Wind damage

Damage level
Please select the first item in this list that applies.







Roof/siding damage

Flood damage

Basement/crawlspace
Damage level
Please select the first item in this list that applies.




Water level
Please select the last item in this list that applies.



Duration water has been present in the structure