Municipal Damage Report
(to be submitted by Municipal EMA Coordinators only)
Date of Damage:
ex. 08-25-2004
Cause of Damage:
Location
Municipality:
Reported By
Name:
Phone:
E-Mail:
Description
Did your local elected officials declare an emergency?
No
Yes
Record applicable numbers below more information will be required later.
Fatalities:
Injured
Missing:
Evacuated:
In Shelters:
Number Of Public Buildings Damaged:
Cost To Fix Public Buildings Damaged:
Number Of Roads Damaged
Cost To Fix Roads Damaged
Number Of Public Bridges Damaged :
Cost to Fix Public Bridges Damaged :
Number Of Public Parks Damaged:
Cost To Fix Public Parks Damaged:
