Initial Damage Assessment Flood

More Damage Assessment information can be found on IEMA's Website. Visit the Damage Assessment page for official forms and details.

INDIVIDUAL ASSISTANCE
INITIAL DAMAGE ASSESSMENT FORM INSTRUCTIONS - For Flood Events
Form and Instructions Revised 12/2017

GENERAL INFORMATION

• County - Include the county where the damage is being assessed.
• Date - Date of Event
• Event - The event that caused the damage.
• Completed by - Name of the person performing damage assessment.
• Phone Number - Phone number, including area code, of person performing damage assessment.
• Date(s) of Assessement Start _____ End _____.

SITE INFORMATION

#1,#2,#3,#4 - ADDRESS #, Unit/Suite #, STREET NAME, CITY

• Indicate address number in Column #1, unit/suite number in Column#2 (if applicable) and street name in the Column #3. For example, the address 105 North Main Street would be recorded as follows:
  Column #1 - 105
  Column #2 - Appt # 2 (if applicable)
  Column #3 - North Main Street
  Column #4 - Springfield
  The apartment number should included after the street name if applicable.
  Recording the address number and street name in separate columns facilitates sorting the data on the spreadsheet if the forms are completed electronically. Be sure to annotate the street direction if applicable. (i.e. North, South, East, West)
• Use a separate entry for each dwelling number and street.
• If damage to individual apartments can be determined, apartments should be listed on separate lines. If all apartments in a building have similar damage, record them as a group on the same line and indicate the number of apartments.
• If there is a business in the home, record the home and business as separate lines and note in the comments.

#5 - TYPE OF STRUCTURE

• Indicate if damaged dwelling is:
  Single Family Home
  Multi Family Structure (Apartment Building, Duplex, 2-Flat, etc.)
  Mobile Home
  Business
• When using the electronic version of the form, select the appropriate dwelling from the drop down menu.

#6 - OWN/RENT

• Indicate if the occupant owns or rents the dwelling by selecting the applicable option from the drop down menu.

#7 - DEPTH - BASEMENT

• Select depth of water in the basement (inches).
• If no water in basement, select 0.
• If the basement is full record Full
• If no basement, select N/A (Not Applicable). (The dwelling may be on a slab or in an upper apartment.)
• If unable to determine select UNKNOWN.

#8 - DEPTH - CRAWLSPACE

• Select depth of water in the crawlspace of the dwelling (inches).
• If no water in the crawlspace, select 0
• If the crawlspace is full record Full
• If there is no crawlspace select N/A
• If unable to determine the depth select UNKNOWN

#9 - DEPTH - 1st FLOOR

• Select depth of water in the first floor of the dwelling (inches).
• If no water in the first floor, select 0.
• If apartment is in the basement or an upper floor, select N/A.
• If unable to determine the depth record UNKNOWN.

#10 - BASEMENT LIVING AREA - YES OR NO

• Determine, if possible, if the basement is used as an essential living area, such as space that is used as a required (versus an optional) bedroom and record Yes, No or N/A.
• Family rooms are not considered essential living areas. A finished basement does not necessarily make it an essential living area. A basement apartment or garden apartment is considered an essential living area. If a dwelling is a split-level or tri-level design, indicate this in the Comments section.
• Select the applicable option from the drop down menu.

#11 - INSURANCE

• Determine what type of Flood insurance the occupant has. Unknown, None, Privately purchased flood insurance or Federal flood insurance (NFIP), Renter, Homeowners or Sewer backup.
• If it can't be determined, select UNKNOWN.
• If they do not have any insurance, select none.
• If they have privately purchased flood insurance, select Flood
• If they have federally purchased flood insurance or NFIP, select Flood
• If they have Sewer backup insurance, select Sewer Backup

#12 - STRUCTURAL DAMAGE - YES OR NO

• If there is obvious/visible structural damage to the dwelling, select Yes and briefly describe the damage in the Comments textbox. If no obvious/visible structural damage, record No. Structural damage is related to the integrity of the structure. Structural damage may include collapsed basement walls and large cracks in the foundation. Structural damage does not include damage to drywall, carpet or paneling. (See FEMA Matrix for definition of structural damage)
• Select the applicable option from the drop down menu.

#13 - FEMA LEVEL OF DAMAGE

• Based off the FEMA matrix record Affected, Minor, Major or Destroyed based on the damage criteria
• Use the drop down menu to assign a level of damage from Affected, Minor, Major, Destroyed, Inaccessible or unknown based off the FEMA Matrix for assigning a level of damage. (See assigned FEMA Matrix for assigning level of damage)

#14 - COMMENTS

• Other types of common information to be recorded in this column using the corresponding letter are:
  A - No one living in dwelling at time of flood
  B - Dwelling was not a primary residence
  C - Damage caused by sewer back up only
  D - No one home during damage assessment, cannot determine damage
  E - No one home during damage assessment, information obtained by observation (waterline on house, for example) or from another source (neighbor, local official)
  F - Water Heater, Furnace and/or Duct work was damaged or is/was not operable due to flood (please annotate which mechanical was damaged or all.)
  N/A - No applicable option.

#15 - ADDITIONAL COMMENTS

• Additional comments are optional. Include any supplemental information we should be aware of. If there is structural damage, briefly describe it here. Examples of brief descriptions are: basement wall collapsed, house off foundation, large foundation cracks.

DEFINITIONS

Business - A sole proprietorship, partnership, or corporation (excludes agricultural enterprises).

Structural Damage - Damage that is related to the integrity of the structure. Structural damage may include collapsed basement walls and large cracks in the foundation. Structural damage does not include damage to drywal, carpet or paneling.

COLUMN HEADING ABBREVIATIONS

SF - Single Family
MF - Multi Family
MH - Mobile Home
B - Business
INS - Insurance
H - Home Owners
R - Renters

COMMENTS COLUMN KEY

A - No one living in dwelling at time of event
B - Dwelling was not a primary residence
C - Roof/Wall covered with tarp or plywood
D - No one home during damage assessment, cannot determine damage
E - No one home during damage assessment, information obtained by observation or from another source (neighbor, local official)
N/A - No applicable option.

Damage Assessment Matrix for Conventionally Built Homes

Category of Damage	Definition	Flood Examples	Non-Flood Examples
Affected	Residences with minimal damage to the exterior and/or contents of the home.	Any water line in the crawl space or basement when essential living space or mechanical components are not damaged or submerged. Damage to a porch, carport, garage, and/or an outbuilding not for commercial use, etc.	Cosmetic damage such as paint discoloration or loose siding. Minimal missing shingles or siding. Damage to an attached structure (e.g., porch, carport, garage, or outbuilding not for commercial use); gutters; screens; landscaping; retaining walls; or downed trees that do not affect access to the residence.
Minor	Encompasses a wide range of damage that does not affect the structural integrity of the residence.	Waterline at 1 to 3 inches in an essential living space. When Waterline exceeds 3 inches but is below 18 inches, damage may be major or minor depending on the following factors: duration of the flood; contaminates in the water; if waterline reached outlets; and number of essential living spaces flooded. Any waterline in a finished basement.	Nonstructural damage to roof components over essential living space to include shingles e.g. roof covering, fascia board, soffit, flashing, and skylight. Nonstructural damage to the interior wall components to include drywall and insulation. Non structural damage to exterior components Multiple small vertical cracks in the foundation. Damage to chimney (i.e., tilting, falling, cracking, or separating from the residence). Damage to mechanical components (e.g. furnace, boiler, water heater, HVAC, etc.). Damage or disaster related contamination to a private well or septic system.
Major	A residence may be categorized as having major damage when it has sustained significant structural damage and requires extensive repairs.	Waterline above 18 inches or the electrical outlets in essential living space. Waterline on the first floor (regardless of depth) of a residence when basement is completely full. When waterline exceeds 3 inches but is below 18 inches, damage may be major or minor depending on the following factors: Duration of the flood; contaminates in teh water; if waterline reached outlets; and number of essential living spaces flooded.	Failure or partial failure to structural elements of the roof over essential living spaces, to include rafters, ceiling joists, ridge boards, etc. Failure or partial failure to structural elements of the walls, to include framing, etc.. Failure or partial failure of foundation to include crumbling, bulging, collapsing, horizontal cracks of more than two inches, and shifting of the residence on the foundation of more than six inches.
Destroyed	The residence is a total loss, or damaged to such an extent that repair is not feasible.	Waterline at the roofline or higher, or complete failure of two or more major structural components (e.g., collapse of basement walls, foundation, walls, or roof).	Only foundation remains. Complete failure of two or more major structural components (e.g., collapse of basement walls, foundation, walls, or roof) A residence has a confirmed imminent danger (e.g., impending landslides, mudslides, or sinkholes).

Assessment Matrix for Manufactured Homes

Degree of Damage	Definition	For Flood Damage	For Damage Other Than Flood (e.g., Wind Driven Rain, Earthquake)
Affected	This category includes residences with cosmetic damage only. It also applies to residences with damage to a porch, carport, garage, and/or an outbuilding not for commercial use, etc.	Residences with damage to a porch, carport, garage, and/or an outbuilding not for commercial use, etc. No damage affecting habitability; cosmetic damage only (e.g., skirting is impacted).	The dwelling's frame is not bent, twisted, or otherwise compromised. No structural components of the dwelling have been damaged (e.g., windows, doors, wall coverings, roof, bottom board insulation, ductwork, and/or utility hook up).
Minor	The residence is damaged and requires minimal repairs.	When the waterline has reached the floor system but has not entered the living space of the unit. Examples of damage include: Bottom board, insulation, or ductwork in the floor system; HVAC is impacted. There is no structural damage to the residence and it has not been displaced from the foundation.	There is no structural damage to the residence and it has not been displaced from the foundation. Nonstructural components have sustained damage - e.g. windows, doors, wall coverings, roof, bottom board insulation, ductwork, and/or utility hook up. Skirting or HVAC is impacted.
Major	The residence has sustained structural or significant damage that require extensive repairs.	Water has covered the floor system and entered the living space of the unit, but is still below the roofline. The residence has been displaced from the foundation, block or piers and other structural components have been damaged.	The residence has been displaced from the foundation, block or piers and other structural components have been damaged.
Destroyed	The residence is a total loss.	The residence is a total loss, for example: Waterline is at the roofline or higher; Residence's frame is bent, twisted, or otherwise compromised.	The residence's frame is bent, twisted, or otherwise compromised. The residence is missing the roof covering or the structural ribbing has collapsed for the majority of the roof system.