Kona Low Storm Impact Survey

Storm Impact Survey

Hawaiʻi Community Lending is gathering information to better understand how the recent storm has impacted our community. If your home or property experienced damage, please complete this short survey. Your responses will help us identify community needs and understand where those needs are across our communities. Questions? Contact kokua@hawaiicommunitylending.com or call us at 808-587-7656. Also, find us on our socials @hawaiicommunitylending on Instagram and Hawai'i Community Lending on Facebook.
First and Last Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Did your home or property experience any damage as a result of the recent storm?*

YesNo
What type of damage did you experience? (Select all that apply)*

Roof damageFlooding (inside home)Structural damage (walls, foundation, etc.)Electrical damagePlumbing/sewer issuesDamage to personal belongingsYard/land damage (erosion, fallen trees, etc.)Cesspool failure (caved in cesspool and needs replacement)Other
Severity of Damage*

1

2

3

4

5

1 is Minimal Damage, 5 is Severe Damage
Is your home currently safe to live in?*

YesNo
Where are you currently staying?*
Are you Native Hawaiian?*

YesNo
Do you live on Hawaiian Home Lands?*

YesNo
Homestead Area*
Do you have a current homeowners insurance policy?*

YesNoI'm not sure
Do you have FLOOD insurance?*

YesNoI'm not sure
Who is your insurance provider for your homeowners policy?*
Have you filed a claim related to this damage?*

YesNo
Have you applied for any disaster assistance?*

YesNo
Would you like to be contacted for assistance or resources?*

YesNo
Damaged Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please describe the damage or your situation in your own words (OPTIONAL):
Please feel free to upload pictures of any damage (OPTIONAL)

Cancelof
Should be Empty: