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Initial
Damage Assessment Report
Name of Family
Property Address
Home Phone Work Phone Cell Phone
Single Family
Type of Property
BusinessMulti-Family (usually Apts) Vacation home - not primary
Ownership
Rent Lease (Business only)Own
Construction Type
ManufacturedMobile HomeWood FrameMasonry Other
Damages (check all that apply)
Roof Impact
Water HeaterHVAC
Foundation Windows Sewer Major AppliancesFurnace
Source of Damages
TornadoWind/Wind Driven RainPrimarily FloodSewer Backup
Other
Estimate of Damages
Repairs Contents Total
Comments
Person Taking Report
Date and Time Report Taken
Electricity
On Off OffOn
Natural Gas
Based on the damages, the property is currently
Habitable Uninhabitable
Water Depth (in feet)
Basement 1st Floor 2nd Floor
DestroyedMajorMinor
Type of Damage