Damage Self Report

Contact Information

Emergency event:

This survey aims to help state and local emergency management officials across Mississippi Identify and understand damages that have occurred during recent natural disaster activity.

Please submit one survey per impacted address.

Reporting damages to Emergency Management is a voluntary activity, is not a substitute for reporting damage to your insurance agency, and does not guarantee disaster relief assistance.

Please provide the following information about yourself:

Your First Name:

First Name is required

Your Last Name:

Last Name is required

Your Phone Number:

Phone Number is required

Your Email:

Email is required

Location

Address:

Address is required

City:

City is required

Zipcode:

Five digit Zipcode is required

State:

State abbreviation is required

Access and Functional Needs

Do you, or anyone in your household, identify as a person with a disability?

Yes

If so, what is the nature of your disability?

Mobility

Vision

Hearing

Cognitive

Other

If Other, please list

Has any of your disability equipment been lost or damaged as a result of this disaster?

Yes

If so, please list the lost or damaged disability item(s)

Description

Is this your primary residence?

Yes

Please enter the following information if this is your property:

Do you have homeowner's insurance?

Yes

Don't Know

Do you have flood insurance?

Yes

Don't Know

Is this a business?

Yes

Don't Know

If this is a business, enter the business name:

Damage Report

Please report damage to the structure; not contents. Provide information on damage done to the roof, walls, floor, HVAC, and any intrusion by water or wind.

Please describe the damage of the structure:

Photo Guidance:

Please provide photos to assist emergency managers understand the scope of impacts in your area. Photos should reflect damages you reported in the survey. The more photos you provide, the better understanding conveyed of impacts in your area. Only return to the property to take photos if it's safe and legal to do so. See more tips provided below.

Take multiple photos from different angles including close-up photos of specific points of damage and photos of the entire structure.
Make sure your photos aren't blurry or obscured.
Double-check your address as well as the location pin on the in-survey map.
Don't submit reports of non-residential structures or outbuildings (barns, carports, fences, or cars).
Don't submit multiple entries for the same residence.
Don't put yourself in a dangerous situation in order to take photos or submit a self-report.

Please upload photos (up to 10) of the property and damage:

Please take a picture of the Front of the home. Please Frame the picture with the front door in the middle of the photo. Please make sure to include all of the front and the roof line from ground level as shown in the illustration.

Add Front Images:

Upload Photos

Please take a picture of the Left of the home. Please Frame the picture with the front door in the middle of the photo. Please make sure to include all of the front and the roof line from ground level as shown in the illustration.

Add Left Images:

Upload Photos

Please take a picture of the Right of the home. Please Frame the picture with the front door in the middle of the photo. Please make sure to include all of the front and the roof line from ground level as shown in the illustration.

Add Right Images:

Upload Photos

Please take a picture of the Rear of the home. Please Frame the picture with the front door in the middle of the photo. Please make sure to include all of the front and the roof line from ground level as shown in the illustration.

Add Rear Images:

Upload Photos

Please take a picture(s) of the Damage of the home. Please Frame the picture with the Damage in the middle of the photo. Please make sure to include only damage to the Home/Living Space.
Damage Examples: Roof Damage, Wall Damage, Interior photos of damage, for flood damage show water in house, water lines left by flooding.
Things not to include: trees down unless they damage the home, fences, dog houses, tool sheds/storage buildings.

Add Damage Images:

Upload Photos