Damage Assessment Form
Please use this form to report your damages to Franklin County EMA. Completion of this form in no way guarantees local, state, or federal assistance. Information submitted within this form will be used by Franklin County and its response partners to determine what assistance is needed and severity of damages.Your name and contact information will not be released to anyone outside of the response.If you need emergency assistance please call 911
Street Address Line 2
State / Province
Postal / Zip Code
Single Family Home
Damage Level Report
Severity of Damage
Inaccessible: Your home or business may have damage but you cannot get to it.
Completely Destroyed: You home is so damaged that will not be able to be repaired.
Partially Destroyed: Your home should be able to be repaired but has major damage.
Minor Damage: Your home has damage, but you can stay in it safely.
Unaffected: Your home is fine, but property has sustained damage.
Property Insurance Status
Business or Agricultural
Do you have any immediate needs?
If you need Shelter, Food, or other NON-EMERGENCY assistance please list them here. If you need EMERGENCY assistance please dial 911.
Property Damage Photo
Property Damage Photo #2
Property Damage Photo #3
Should be Empty:
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