Emergency Management Apps

Public Assistance Applicant Damage Report

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.

Public Assistance Applicant Damage Report iPhone, iPad Public Assistance Applicant Damage Report Android Public Assistance Applicant Damage Report Web, Desktop
Public Assistance Applicant Damage Report

Demographics-General Information

Damages Caused by (check all that apply)

County

Applicant Name

Kick-Off Meeting Date

Kick-Off Meeting Time

Kick-Off Meeting Address

PAC

PAC Phone Nbr

Applicant Representative

Applicant Representative Title

Applicant Representative Phone

Did your damages include the following

Do you have a map of your locality illustrating where damages occurred?

Debris

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)

Facility Type

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)?

Culvert Size

Bridge Type

Bridge Damages

Length

Width

Depth

Which of the following will be used to repair / replace damaged facility?

Force Account Labor

Force Account In-Place Cost

Foreman's Truck

Foreman's Truck hours

Grader

Grader Hours

Dump Truck

Dump Truck Hours

Backhoe

Backhoe Hours

Loader; Crawler

Loader, Crawler Hours

Loader, Wheel

Loader, Wheel Hours

Excavator, Hydraulic

Excavator hours

Rented Equipment

Gravel (Tons)

Gravel ($/Ton)

Asphalt (SY)

Asphalt Cost per SY

Chip Seal - Volumes (SY)

Chip Seal - $ per SY

CMP ($/LF)

Material Costs

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?

Utilities

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.