About the App
States can conduct their own public assistance damage assessments prior to FEMA involvement. The system was designed using the FEMA Public Assistance Guide with questions built for all Categories A-G. By providing FEMA access to your Fulcrum account data they will have what they need to conduct desk top validations prior to field deployment. This will help streamline joint agency onsite assessments and lead toward more timely disaster declaration and project formulation. This app is fully customizable to fit your specific damage assessment forms, and works offline in case of inclement weather or no internet signal.
Damages Caused by (check all that apply)
Kick-Off Meeting Date
Kick-Off Meeting Time
Kick-Off Meeting Address
PAC Phone Nbr
Applicant Representative Title
Applicant Representative Phone
Did your damages include the following
Do you have a map of your locality illustrating where damages occurred?
Cat. A: Site Name
What type of debris was produced by this event (check all that apply)?
Do you have insurance coverage for the removal of debris?
How much debris was produced by the storm that affected public property?
What types of property received significant debris?
Were any services affected by the debris (check all that apply)?
Please describe volume, duration and extent of interruption.
Has all the debris been removed?
When was the debris removed?
How was the debris removed (check all that apply)?
Where was the debris removed to (name + address or gps coordinates)
When do you anticipate having all the debris removed?
Are there any obstacles to removing the debris?
Please describe the obstacles to remove debris on a timely basis?
How will the debris be removed (check all that apply)?
Where will the debris be removed to (name + address or gps coordinates)
Emergency Protective Measures
Cat. B: Site Name
Did the community perform any of the following protective measures?
Were any of the following essential services impacted by the event?
Are additional resources needed?
Roads & Bridges
Cat. C: Site Name (Road Name & / Or Intersection)
Who is responsible for the maintenance?
Describe the damages:
Has this type of damage occurred before (in prior events)?
How many times has this occurred?
Has this damage affected any of the essential services (check all that apply)?
Which of the following will be used to repair / replace damaged facility?
Force Account Labor
Force Account In-Place Cost
Foreman's Truck hours
Dump Truck Hours
Loader, Crawler Hours
Loader, Wheel Hours
Asphalt Cost per SY
Chip Seal - Volumes (SY)
Chip Seal - $ per SY
What is the anticipated cost to restore or replace?
Please describe the impact to essential services.
What percent of work needed to bring facility back to its pre-disaster function and capacity has been completed?
Water Control Facilities
Cat. D: Site Name
What kind of facility was damaged?
Please describe damages (include name, size, quantity, location...)
Were any services impacted as a result of the damages to this facility?
Please describe what services have been impacted and their effect on the community.
How much (percentage) of the work has been completed?
What percent or dollar amount do you anticipate as being covered by insurance?
What is or what do you anticipate the total cost to bring facility back to its pre-disaster function and capacity?
Buildings & Equipment
Cat. E: Site Name
What services does this building house?
Are services still on-going at this location?
Who owns the building?
As a result of the damages, does this facility constitute a hazard to the public safety or private property?
Please elaborate on threat to public safety or property.
Is this facility listed on the National, State or Local Historic Register or carry any historic or environmental significance?
Please elaborate on facility's historic / environmental significance.
Is this facility in a floodplain?
What is the construction type?
Did you sustain damages to the following?
What percent or dollar amount do you expect your insurance to cover?
What is or do you expect to be the total cost of damages incurred at this site?
Cat. F: Site Name
What type of utility or component suffered damages?
Who is responsible for the repairs / replacement?
Are / Were critical services impacted as a result of damages to this facility?
Please provide impact or disruption of services.
Has this facility sustained damages in previous events?
Were corrective measures taken (mitigation) to prevent recurrence?
What has been the State and Local response surrounding the damages to this facility?
What dollar amount or percentage of total costs to you anticipate to be covered by insurance?
What do you anticipate the total cost to be for repair/ replacement of this facility?
What is the location of the sub-station?
Please provide extent of damages to this sub-station including how many were damaged
Do you have insurance coverage on this sub-station?
Did you incur damages to the transmission lines?
Was this aerial or underground?
What is the transmission line voltage?
Please provide the voltage (kv).
What type of structure was damaged?
How many structures were damaged?
How many were damaged?
What type of Phase (in American Wire Gauge units)
Please describe type of Phase
Please identify Pole dimensions (height, classification, single circuit or underbuilt, crossarms)
Please choose Shield type
Please choose wire type
Please provide size (American Wire Gauge units) and type
Can you (please select one of the following):
How much ($) do you anticipate receiving in recycling/salvage fees?
Please describe the transformer:
Please advise size (kva) of transformer
Was there a spill?
Was it (select from the following):
Please advise location of spill
Please advise how the spill was or will be cleaned up and where it was or will be disposed.
Regulator: Please advise the capacity and voltage
Capacitor Banks: Please advise type of switches
Please list damages, transformer type and conductors
Parks & Recreation
Cat. G: Site Name
Please advise the type of facility that has sustained damages
Please list the facility functions
Please advise who has responsibility for this facility.
Please list in detail all damages sustained to this facility including dimensions, materials, extent of damage (repair/replace), etc.
Please advise the anticipated percentage of reimbursement to be received from the insurance carrier.
Please advise expected costs to return facility back to its pre-disaster function and capacity.