• Location Name:

  • Device GPS Location: Press Locate. Then Locate Me
  • Conducted on

  • Team Name/Number

  • This damage assessment tool was created to provide an electronic method to instantly report damage from the field to the EOC or ICP.


  • Property Type

  • Street Number

  • Street Name

  • Lot Number

  • City

  • GPS Coordinates (Degrees, Decimal Minutes) (EXAMPLE: N 43 34.3303 W 85 54.7232)

  • Property Owner Name and Phone Number (if known)


  • Incident Hazard

  • Damage Classification

  • Pressing on the question text allows you to enter additional information and add photos.

  • Debris Present? If yes what types of debris? Please take photo of debris.

  • Flooding Observed? What is the level of flooding in feet and inches. Please take photo of flooding.

  • 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.

  • 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.


  • Please remember to take each photo with the number associated on you DA worksheet.

  • Mail Box or House Numbers

  • Street View

  • Front Door

  • Damage Details 1

  • Damage Details 2

  • Damage Details 3

  • Please draw a quick aerial sketch of the house and the damage.


  • Please enter any additional comments for this property.


  • Please enter the date, time, and electronically sign. Submit this damage report or save it and move on to the next property.

  • Type Your Name

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.