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Damage, Injury, Hazard, and Needs Report
Complete this form every 12 hours after a Disaster and submit it to the Disaster Hub.
Incident | |
Reporter | |
Street | |
Date & Time of Survey |
Damage | ||||||||
|---|---|---|---|---|---|---|---|---|
Category | Extent | |||||||
Location/Address | Single-Family Home | Apartment | Mobile Home | Commercial | Public | Destroyed | Major | Minor |
Injuries | ||||
Injury | Approximate Age of Victim | Details | Severity | Treatment (if any) |
Hazards | ||||||
Location | Flooding | Fire | Gas Leak | Downed Power Line | Hazmat | Structural Collapse |
Needs | |
Category | Specifics (amount, reason, etc.) |
Food | |
Water | |
Shelter | |
Medical | |
Fire | |
Police | |
Utility | |
Domestic Animal Care |
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