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 Events Other Than Floods
Form and Instructions Revised 12/2017
GENERAL INFORMATION
County - Include the county where the damage is being assessed.
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.
Email - Email address of person performing damage assessment. A confirmation email will be sent.
Date(s) of Assessement Start _____ End _____.
Excel Upload
Site information can be entered into the spreadsheet found here. Use the upload button to select the XLXS file that contains the data you want to upload. The application will accept all completed rows until a blank Address Number cell is found.
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:
SF - Single Family Home
MF - Multi Family Structure (Apartment Building, Duplex, 2-Flat, etc.)
MH - Mobile Home
B - Business
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 - HABITABLE STATUS
Indicate if the damaged structure is ONE of the following.
Habitable Without Repair
Minimal damage to structure and occupant can live in the dwelling without making rapairs.
Shingles missing on small area of roof.
Gutters and soffit torn from house.
Select the applicable option from the drop down menu.
Habitable with Few Repairs
House is damaged and uninhabitable but may be made habitable in a short period of time.
Windows and/or doors blown in.
Less than 50% damage to dwelling/business (not based on dollar value of structure).
Shingles missing on small area of roof.
Gutters and soffit torn from house.
No holes in walls or roof or very small holes that do not impact structural integrity.
Select the applicable option from the drop down menu.
Uninhabitable/Needs Extensive Repair
Substantial roofing elements damaged or missing (e.g., roof decking, trusses/framing).
Damage to windows, doors, exterior walls, interior wind damage, rain/water damage, extensive debris and utility problems.
Mobile home is pushed off foundation.
Select the applicable option from the drop down menu.
Total Loss/Not Feasible to Repair
Only foundation remains.
Two or more walls destroyed and roof substantially damaged or destroyed.
Mobile home is pushed off foundation/mobile home frame damaged/twisted.
Select the applicable option from the drop down menu.
#8 - INSURANCE
Determine the occupant's type of insurance. (Home Owners, Renters, Flood, Sewer, None or Unknown).
Select the applicable option from the drop down menu.
#9 - FEMA LEVEL OF DAMAGE
Based on the FEMA matrix record the category of damage Affected, Minor, Major or Destroyed based off of the assessment.
Select the applicable option from the drop down menu.
#10 - 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 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.
#11 - 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).
Habitable - Essential living areas are safe, secure and sanitary so that the home can be occupied.
Uninhabitable - Home cannot be occupied because essential living areas are not safe, secure or sanitary.
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.
Partial missing shingles or siding.
Cosmetic damage such as paint discoloration or loose siding.
Broken screens.
Gutter damage and debris.
Damage to an attached structure such as a porch, carport, garage, or outbuilding not for commercial use.
Damage to 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.
Water line up to 18 inches in an essential living space.
Damage to mechanical components (e.g. furnace, boiler, water heater, HVAC, etc.).
Nonstructural damage to roof components over essential living space to include shingles e.g. roof covering, fascia board, soffit, flashing, and skylight.
Non structural damage to the interior wall components to include drywall, insulation
Non structural damage to exterior components
Multiple small vertical cracks in the foundation.
Damage to chimney to include, tilting, fallen, cracks, or separated 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.
Water line above 18 inches in an essential living space, a water line above the electrical outlets, or a waterline on the first floor of a residence when basement is completely full.
Failure or partial failure to structural elements of the roof over required rooms to include rafters, ceiling joists, ridge boards, etc.
Failure or partial failure to structural elements of the walls to include framing, sheathing, etc.
Failure or partial failure to 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.
Complete failure of two or more major structural components (e.g., collapse of basement walls, foundation, walls, or roof).
Only foundation remains.
A residence that will require immediate demolition or removal because of disaster-related damage or 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.
No damage affecting habitability; cosmetic damage only.
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.
Water line is below the floor system.
Skirting or 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 come into contact with the floor system.
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.
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.