Irene Damage Assessment surveyIrene Damage Assessment survey

*

1. Please provide the following contact information:

Please provide the following contact information: Name:
Address:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

2. Has your residence or business sustained STRUCTURAL damage due to flooding or wind damage from Irene?

Has your residence or business sustained STRUCTURAL damage due to flooding or wind damage from Irene? Yes

No

Other (please specify)

3. Is damage visible from the outside of the structure?
This will help damage assessment teams determine if appointments will need to be scheduled with property owners

Is damage visible from the outside of the structure? This will help damage assessment teams determine if appointments will need to be scheduled with property owners Yes

No

4. Is this property a:

Is this property a: Single Family home

Multi-Family home

Business (including neighborhood associations reporting damage to bridges or seawalls)

Mobile home

Other (please specify)

5. Brielfly describe the structural damage to your residence or business

Brielfly describe the structural damage to your residence or business

6. If you're reporting other property damage, such as fallen trees and limbs, or cars that were damaged due to flood waters or trees, please describe the damage below.

If you're reporting other property damage, such as fallen trees and limbs, or cars that were damaged due to flood waters or trees, please describe the damage below.

7. Is this property occupied by:

Is this property occupied by: Owner

Renter

8. Is this propery accessible for inspection at a later date?

Is this propery accessible for inspection at a later date? Yes

No

9. Are you still able to live in the home or stay open for business?

Are you still able to live in the home or stay open for business? Yes

No

10. What type of insurance do you have for this property?

What type of insurance do you have for this property? Structure and Contents

Contents

Flood

None

11. Have you contacted your insurance company and also documented the damage for your own records (ie photos, video)?

Have you contacted your insurance company and also documented the damage for your own records (ie photos, video)? Yes

No

Unsure

12. For business owners: did you have to close your business as a result of the storm, if yes, please briefly describe impact on your operations (ie # of days closed, income lost, etc)

For business owners: did you have to close your business as a result of the storm, if yes, please briefly describe impact on your operations (ie # of days closed, income lost, etc)

Irene Damage Assessment survey
Exit this survey

1. Default Section

Irene Damage Assessment surveyExit this survey

1. Default Section

Irene Damage Assessment survey
Exit this survey