Wahkiakum County Department of Emergency Management
Preliminary damage assessment (PDA) collection form

This form is designed to collect information so County officials can get a better understanding of the impacts to Wahkiakum County. This information can also help the County and possibly it's residents potentially qualify for disaster assistance. ** There is no guarantee of funding

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* 1. Your Contact information

Name *

Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address

Phone Number *

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* 2. Have you suffered damage from the Winter Storm and or flooding during the December 2021 and January 2022 storms?

Yes

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* 3. Is the damage you are reporting within Wahkiakum County WA?

*** THIS FORM IS DESIGNED TO COLLECT INITIAL AND BASIC DAMAGE ASSESSMENT INFORMATION. YOU WILL BE CONTACTED FOR MORE INFORMATION IN THE COMING DAYS.

Yes

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* 4. Did the damage arise from the Winter Storm and/or Flooding during December 2021 to January 2022?

Yes

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* 5. What is the physical address of the damage you are reporting? *** If you are reporting damage for multiple addresses please complete a new form for each address.

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 6. Please briefly describe the related damage.

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* 7. Picture 1/20 - Please add up to 20 pictures to help us get a good idea of the damage.

Please add up to 20 pictures to help us get a good idea of the damage.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Wahkiakum County Department of Emergency Management Preliminary damage assessment (PDA) collection form

Question Title

* 1. Your Contact information

Question Title

* 2. Have you suffered damage from the Winter Storm and or flooding during the December 2021 and January 2022 storms?

Question Title

* 3. Is the damage you are reporting within Wahkiakum County WA?*** THIS FORM IS DESIGNED TO COLLECT INITIAL AND BASIC DAMAGE ASSESSMENT INFORMATION. YOU WILL BE CONTACTED FOR MORE INFORMATION IN THE COMING DAYS.

Question Title

* 4. Did the damage arise from the Winter Storm and/or Flooding during December 2021 to January 2022?

Question Title

* 5. What is the physical address of the damage you are reporting? *** If you are reporting damage for multiple addresses please complete a new form for each address.

Question Title

* 6. Please briefly describe the related damage.

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* 7. Picture 1/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 8. Picture 2/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 9. Picture 3/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 10. Picture 4/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 11. Picture 5/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 12. Picture 6/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 13. Picture 7/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 14. Picture 8/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 15. Picture 9/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 16. Picture 10/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 17. Picture 11/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 18. Picture 12/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 19. Picture 13/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 20. Picture 14/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 21. Picture 15/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 22. Picture 16/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 23. Picture 17/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 24. Picture 18/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 25. Picture 19/20 - Please add up to 20 pictures to help us get a good idea of the damage.

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* 26. Picture 20/20 - Please add up to 20 pictures to help us get a good idea of the damage.

Wahkiakum County Department of Emergency Management
Preliminary damage assessment (PDA) collection form

* 3. Is the damage you are reporting within Wahkiakum County WA?

*** THIS FORM IS DESIGNED TO COLLECT INITIAL AND BASIC DAMAGE ASSESSMENT INFORMATION. YOU WILL BE CONTACTED FOR MORE INFORMATION IN THE COMING DAYS.