Initial Damage Estimate Form

Completion Instructions

SUMMARY:

This form is intended to provide local jurisdictions with a standard method of reporting "initial" damage estimates to SEMA. This information will be used to assess the situation throughout the affected area. It will also be combined with other reported information and used to help decide on future actions.

These forms are intended to be "cumulative". If you submit additional reports, all of the columns MUST show current totals. For example, if the first form you submitted showed sixteen (16) residential structures damaged and you identify four (4) more damaged residential structures, the next form you submit MUST show twenty (20) damaged residential structures. This way the previous form can be destroyed without losing any information.

The form is divided into three (3) main sections. These sections are as follows:

1.  Incident:

	a.  INCIDENT:  Briefly describe the incident that generated the
submission of this report.  Include the areas affected, the date of the
incident, and the time of the incident.

	b.  NAME OF POLITICAL SUBDIVISION:  List the name of the affected
city, town, county, etc.

	c.  POINT OF CONTACT:  List the name of the individual we can
contact if their are any questions concerning the report.

	d.  TITLE:  List the Point of Contact's title (Mayor, Commissioner,
Emergency Management Director, etc.)

	e.  COUNTY:  List the County where the affected jurisdiction is
located.

	f.  BUSINESS TELEPHONE:  List the office telephone number where the
Point of Contact can be reached.

	g.  HOME TELEPHONE:  List the telephone number where the Point of
Contact can be reached after normal work hours.

	h.  BUSINESS ADDRESS:  List th complete address of the Political
Subdivision.

2.	INDIVIDUAL ASSISTANCE:

	a.  INDIVIDUALS:
		
		(1)  # FATALITIES:  List the number of fatalities associated
with the incident.  (Do not include these numbers in the Number Affected.)

		(2)  # INJURIES:  List the number of individuals who are
injured as a result of the incident.  (Do not include these numbers in the
Number Affected.)

		(3)  # AFFECTED:  List the number of people affected by the
incident (excluding fatalities and injured.)

		(4)  # SHELTERS OPEN:  List the number of shelters that are
currently open as a result of the incident.

		(5)  # IN SHELTERS:  List the number of people that are
currently located in the shelters.

	NOTE:  Items 1, 2, and 3 do NOT duplicate each other.  For example,
a "fatality" would not also be counted as "injured" or "affected".  The
intent is that we would be able to add all three of these items together
without duplicating any numbers.

	b.  STRUCTURES:

		(1)  RESIDENTIAL DAMAGED:  List the number of residential
properties that were damaged as a result of the incident.

		(2)  RESIDENTIAL DESTROYED:  List the number of residential
properties that were destroyed as a result of the incident.

		(3)  COMMERCIAL DAMAGED:  List the number of commercial
peoperties that were damaged as a result of the incident.

		(4)  COMMERCIAL DESTROYED:  List the number of commercial
peoperties that were destroyed as a result of the incident.

3.  PUBLIC ASSISTANCE:

This section is divided into seven (7) separate categories.  When providing
estimates of your incident related costs, please separate those costs into
the most appropriate category.  The seven categories are as follows:

	a.  CATEGORY A (DEBRIS REMOVAL) ESTIMATE:
	
	b.  CATEGORY B (PROTECTIVE MEASURES) ESTIMATE:

	c.  CATEGORY C (ROAD SYSTEMS) ESTIMATE:

	d.  CATEGORY D (WATER CONTROL FACILITIES) ESTIMATES:
	
	e.  CATEGORY E (BUILDINGS AND EQUIPMENT) ESTIMATE:

	f.  CATEGORY F (PUBLIC UTILITY SYSTEMS) ESTIMATE:

	g.  CATEGORY G (OTHER) ESTIMATE:

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