Initial Disaster Estimate

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INCIDENT (Brief Description and date of incident):

Name of Political Subdivision

Point of Contact *

Title

County

Business Address

Business Telephone *

Home Phone

Email

  These fields are required.


INDIVIDUAL ASSISTANCE

INDIVIDUALS

Fatalities (*): Injuries(*): # Shelters Open # In Shelters

# Affected

*DO NOT INCLUDE THESE IN # AFFECTED!

STRUCTURES

Residential:

Damaged:

Destroyed:

Commercial:

Damaged:

Destroyed:


PUBLIC ASSISTANCE

CATEGORY	TYPE		DESCRIPTION		ESTIMATE ($)

  A	    Emergency	DEBRIS CLEARANCE			

  B		Emergency  	PROTECTIVE MEASURES	

  C		Permanent	ROAD SYSTEM		

  D		Permanent	WATER CONTROL FACILITY	

  E		Permanent	BLDGS AND EQUIPMENT	

  F		Permanent	PUBLIC UTILITY SYSTEMS	

  G		Permanent	OTHER			




  




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