Flood - April 18, 2013

 
*
1. ADDRESS 1: Indicate your address number
*
2. ADDRESS 2: Indicate your street name
*
3. SF/MF/MH/B: Indicate if damaged dwelling is: SF - Single Family Home; MF - Multi Family Structure (Apartment Building, Duplex, 2-Flat, etc.); MH - Mobile Home; or B - Business.
*
4. OWN/RENT: Does the occupant own (O) or rent (R)?
5. DEPTH - BASEMENT: Indicate depth of water in the basement (in inches--so 1' 6" = 18) If no water in basement, enter 0, If no basement skip this question.
6. DEPTH - 1st FLOOR: Indicate depth of water in the first floor of the dwelling. Indicate depth of water (in inches--so 1' 6" = 18) If no water in the first floor, enter 0. If apartment is in the basement or an upper floor, skip this question.
*
7. BASEMENT LIVING AREA: Is the basement used as an essential living area, such as space that is used as a required (versus an optional) bedroom?

Family rooms are not considered essential living areas. A finished basement does not necessarily make it an essential living area. A basement apartment or garden apartment is considered an essential living area. If a dwelling is a split-level or tri-level design, indicate this in the Comments section.
*
8. INS-H/R/F: Do you have Home Owners insurance (H); Renters insurance (R); Flood insurance (F); no insurance (N); cannot be determined (UNK)?
*
9. STRUCTURAL DAMAGE: If there is obvious/visible structural damage to the dwelling, record Y (for Yes) and briefly describe the damage in the Comments section. If no obvious/visible structural damage, record N (for No). Structural damage is related to the integrity of the structure. Structural damage may include collapsed basement walls and large cracks in the foundation. Structural damage does not include damage to drywall, carpet or paneling.
10. COMMENTS:
If there is structural damage, briefly describe it here. Examples of brief descriptions are: basement wall collapsed, house off foundation, large foundation cracks.

Other types of common information to be recorded here, using the corresponding letter, are:
A - No one living in dwelling at time of flood
B - Dwelling was not a primary residence
C - Water in crawl space only
D - Damage caused by sewer back up only
E - No one home during damage assessment, cannot determine damage
F - No one home during damage assessment, information obtained by observation (waterline on house, for example) or from another source (neighbor, local official)
11. Comments from Question #10
Powered by SurveyMonkey
Check out our sample surveys and create your own now!