Initial Damage Assessment / Windshield Survey

{var Title}

 
  Jurisdiction     Mission or Incident #  

     Event      If OTHER; Description    

Survey Area     Survey Team  

  Start Date of Event  
           Date of this Survey    

Affected
10 %
Minor
25 %
Major
50 %
Totaled
100 %
Total
Number
$ Loss 
CATEGORY                                                    # # # # Count $ Estimate
HOUSES
APARTMENT COMPLEX
MOBILE HOMES
RESIDENTIAL HIGH RISE BUILDING 
COMMERCIAL HIGH RISE BUILDING
PUBLIC BUILDINGS
SMALL BUSINESS
FACTORIES / INDUSTRIAL COMPLEX
ROADS
BRIDGES
ELECTRICAL DISTRIBUTION
SCHOOLS
Total Dollar Amount:
COMMENTS (if any by the survey team)

{var Comments}
                                                                                         Express Sender               Ver 11.3