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Home
Wallowa County Damage Survey
Home
Wallowa County Damage Survey
Wallowa County Damage Survey
Current
submit
Complete
Tell me about the structure that was damaged. Are you the
Primary Home Owner
Tenant
Landlord
Business Owner
Business Renter
Other…
Enter other…
Personal Information
Primary Contact- First Name
Primary ContactFirst Name
Middle
Primary Contact- Last Name
Age
DOB
Email
Primary Phone Number
Your Name
Secondary First Name
Secondary Last Name
Secondary Email
Secondary Phone Number
What are your preferred pronouns?
he/him/his
she/her/hers
they/them/theirs
zie/zir/zirs
Prefer not to answer
Address damaged by hailstorm
Street Number
Street Name
City/Town
State/Province
ZIP/Postal Code
Mailing Address
Street Number
Street Name
City/Town
State/Province
ZIP/Postal Code
What is the best way to contact you?
Email
Phone
Mail
What time of day is best to reach you?
Early Morning, before 8AM
Morning after, 8AM
Afternoon
Evening, after 5PM
All of the above
None of the above
Housing
Who is living in the household?
Single Man W/No Children
Single woman W/No Children
Couple W/No Children
Single Man W/ Children
Single woman W/ Children
Couple W/ Children
Roomate
Senior
Disabled
Veteran
Pets
Other…
Enter other…
What type of building structure was damaged?
Stick Built
Manufactured Home
Mobile Home
Mobile homes also known as trailers are homes on wheels that prior to 1976 were mass-produced with little building regulation and control from the government.
Modular Home
Modular homes are also built in factories but are governed by local state building codes. Modular homes are either built on a permanent chassis or on a temporary one.
RV
Apartment Building
Other…
Enter other…
Tell us about your housing situation before the hailstorm?
Renter
Owner
Caretaker
Subsidized Housing
Government Housing
Renter- House
Renter-Apartment
Landlord
Mobile Home/Trailer
RV
Additional Information
Tell us about your post-disaster housing assessment. Please check all that apply to you.
Stably Housed
At risk of losing your house
Homeless
Debris removal inside home
Debris removal outside home
windows insulated for winter
Roof Tarped before winter
Do you have a contractor lined up
Other…
Enter other…
Additional Post-Disaster Information
What type of impact did you experience from the hailstorm?
Primary Car
Windows (wood-framed))
There is a potential wood window glass replacement workshop in the spring. Would you like more information as it becomes available?
Windows (other than wood)
Doors
Roof
Siding
Outbuildings
Agriculture
Animals/livestock
Infrastructure
Fencing
Loss of business income
Damages to business structure(s)
Other…
Enter other…
Additional Impact Details
Was your heat source damaged in the hailstorm?
Yes
No
If yes, tell us about your heat source and the damage.
Repairs
What would it take to become safe, sanitary and secure again?
Volunteer Information
Due to the hailstorm, do you need volunteer help winterizing your home?
Yes
No
What is your availability for volunteers to help you?
Weekday Mornings
Weekend Mornings
Weekday Afternoons
Weekend Afternoons
We may be able to support you with winterizing your windows by providing volunteers and materials (insulation and moisture barriers). Can you explain how you would utilize the volunteers?
Questions to Consider:
Windows
How Many windows
Do you currently have plywood over the windows?
Is there a barrier between the plywood and the home?
Is there window glass still in the window?
Is the window frame still in the window?
What type of window frame wood vinal etc..?
Anything else we need to know about your windows?
When do you expect to get your windows replaced?
We may be able to support you with winterizing your roof by providing volunteers and materials (tarps). Can you explain how you would utilize the volunteers?
Questions to Consider:
Roof
Tell me about your roof.
What type of roof do you have?
How many holes? Is it one section or many?
Do you need help tarping your roof or can you do it?
Do you have a tarp or do you need one?
Do you know how many square feet your roof is?
When do you hope to get your roof repaired or replaced?
Anything else we need to know about your hailstorm damage?
Insurance
Do you have home insurance?
Yes
No
If yes, where are you currently with your claim process?
Are you experiencing difficulties with your insurance company/claim adjuster?
Yes
No
Have you filed a complaint with the Division of Financial Regulation (DFR)?
Yes
No
Have you been in contact with the Division of Financial Regulation (previously known as the Insurance Commissioner office)?
Yes
No
Would like to be contacted by an Insurance advocate? -please provide name and phone number
Yes
No
Vehicle
Was there damage to your primary source of transportation?
Yes
No
The Long Term Recovery Group may be able to help you with your primary source of transportation. What do you need to make sure you have one operating vehicle for the household??
Do you have vehicle Insurance that covers hail damage on your primary vehicle?
Yes
No
Is there anything else we should know about your vehicle insurance?
Disaster Case Management
Are you interested in working with a Disaster Case Manager to support your outstanding hailstorm-related needs?
Yes
No
Tell us how would you prioritize your outstanding needs?
Type of Income
This section is only needed if the survivor would like to use a Disaster Case Manager
What type or types of income do you have?
Employment
Child Support
SSDI
Retirement
Unemployment
DSHS
VA Benefits
Other…
Enter other…
Non Cash Benefits
Food Stamps
Medical
Did you serve in the US Military Service?
Yes
No
When did you serve?
What is you status?
Health and Safety Check
This section is only needed if they are using a Disaster Case Manager
How would you describe your health?
Good
Fair
Poor
Do you have a disability?
Yes
No
Do you have any chronic health conditions?
Yes
No
Do you have mental illness?
Yes
No
Do you have any chemical dependency concerns?
Yes
No
Are you receiving any care for any of the above conditions? Would you like support finding help?
Resources ad Referrals
Let's talk about referrals that may support you becoming safe, sanitary and secure.
Housing(motel, rental assistance, shelter, trailer, RV parks)
Community Based Organizations
Local Churches
DSHS (food, gas, medical)
Legal (housing specific)
Medical
Mental Health
L&I Website
Insurance( Division of Financial Regulation)
Winterization(firewood, skirting for temporary housing)
Volunteer support for roof and/or windows
Agriculture
Animals/livestock
Financial Assistance
Fencing
Other…
Enter other…
Additional Resource and Referral Information
Additional Notes/Comments
Additional Notes/Comments
Disaster Intake Specialist, After listening to the survivors story how would you rate this case?
Tier 1
Tier 1 – Immediate needs met, stable, some remaining unmet needs; quarterly monitoring to update status or may be closed due to lack of resource for identified need (may be reopened if resource(s) becomes available during period of performance).
Tier 2
Tier 2 – Some remaining unmet needs or in current rebuild/repair status; monthly contact to monitor progress.
Tier 3
Tier 3 – Significant unmet needs, Disaster Recovery Plan being developed and monitored; bi-weekly or weekly contact.
Tier 4
Tier 4 – Immediate and long-term unmet needs, may lack capacity, or be highly dependent on social services due to low literacy, elderly, low income, or disabled, weekly contact.
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