Flood Loss Assessment Form
1. General Information
Name of Property Owner
Contact Number
Address
Date of Flood Event
2. Property Details
Type of Property
Residential
Commercial
Industrial
Other
Estimated Floor Area Affected (sq ft or m²)
3. Flood Impact
Estimated Water Depth (ft or m)
Rooms/Areas Affected
Structural Damages (describe)
Contents Damaged (furniture, equipment, etc.)
Estimated Loss Value (currency)
4. Additional Information
Other Losses or Comments