Damage Self Report

This form is for Initial Damage Reporting only. If there is an emergency, please dial 911.

This form is sent to the Summit County Emergency Management. THIS IS VOLUNTARY. Your participation helps us collect reports of damages so we have the ability to assess the highest impacted areas. This is not a form for local, state, or federal assistance.

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Location

Emergency event:

Address:

Address is required

City:

Zipcode:

Five digit Zipcode is required

Description

This report is for:

Home

Business

Damage Report Type is required

Business name:

What is the occupancy type?

Owner

Renter

What type of dwelling?

Single Family

Multi Family

How many units are there?

Do you have insurance?

Yes

Don't Know

Specify Insurance Type

Flood

Homeowners

Renters

Sewer Backup Rider

Please describe the damage:

Do you have a basement?

Yes

Don't Know

Water height in basement (in inches):

If none, please put 0

Water height above first finished floor (in inches):

If none, please put 0

Add Images of Damaged Property:

Upload Photos

Contact Information

Please provide the following information about yourself:

Your Name:

Your Phone Number:

Your Email: