Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
PROPERTY DEMOGRAPHICS
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Incident Hazard
- Wind Damage
- Tornado
- Flood
- Wildland Fire
- Structure Fire
- Snow Damage
- Ice Damage
- Collapse
- Vehicle Crash
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Street Number
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Street Name
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Lot Number
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City
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GPS Coordinates
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Property Owner Name and Phone Number (if known)
DAMAGE INFORMATION
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Type of Damage
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Damage Classification
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Selecting "NO" allows you to enter additional information and add photos.
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Debris Present? If yes what types of debris? Please take photo of debris.
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Flooding Observed? What is the level of flooding in feet and inches. Please take photo of flooding.
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Fallen Trees? Are these trees dead or alive? What size are the trees? How did they fall (twist, uprooted, ect). Please take photo of fallen trees.
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Fallen PowerPoles? CAUTION AROUND DOWN POWERLINES.... TREAT EVERY POWERLINES AS IF IT WAS ALIVE!!! Is power out in the immediate location? Is there a fire from the down POWERLINES? How did the lines or poles come down. Please take photo of the down lines.
PHOTOS
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Please remember to take each photo with the number associated on you DA worksheet.
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Mail Box or House Numbers
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Street View
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Front Door
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Damage Details 1
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Damage Details 2
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Damage Details 3
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Please draw a quick aerial sketch of the house and the damage.
ADDITIONAL COMMENTS
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Please enter any additional comments for this property.
SUBMIT DAMAGE REPORT
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Please enter the date, time, and electronically sign. Submit this damage report or save it and move on to the next property.
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Select date
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Add signature
