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Home My WebLink AboutDisaster Summary Outline Date: _____________ Time: ____________ Date: Time: Disaster Summary Outline GENERAL Jurisdiction (County/City): __________________________________________ Population: ___________ Type of Disaster (Flood, Hurricane, Tornado, etc.) ____________________________________________ _____________________________________________________________________________________ If this is a flood event, does the City/County participate in the National Flood Insurance Program (NFIP)? Yes/No Inclusive dates of the disaster: ____________________________________________________________ Was a local disaster declaration issued? Yes/ No (Not applicable for Agriculture assistance only) Contact Person: _________________________________________ Title: _________________________ Address: ___________________________________ City: ________________ Zip Code: _____________ Phone ( )___________________ Fax ( ) ____________________ Pager ( )___________________ 24-Hour Duty Officer/Sheriff’s Office ( )________________ INDIVIDUAL ASSISTANCE Casualties : (Contact local area hospitals) A. Number of Fatalities _______________ B. Number of Injuries _______________ C. Number Hospitalized _______________ Number of homes isolated due to road closure (high water, etc.):__________________________________ Agricultural Losses : (Contact the Farm Service Agency in your county) Is agricultural assistance needed? Yes/ No If yes, please attach USDA flash situation report. Residential Losses - Primary Residence Only: (Local Damage Assessment) See guidelines on page 4. Type of Minor Major % Covered by Homes Affected Damage Damage Destroyed Insurance Single Family Homes Mobile Homes Multi-Family Units Totals TDEM-93 - Page 1 (Rev. 5/10) Estimated number of persons whose situation will not be satisfied by volunteer organizations (Contact local volunteer organizations) _________________________ Are shelters opened? Yes/No How many? ______________ Name, location, capacity, and current occupancy of shelters? _____________________________________________________________________________________ _____________________________________________________________________________________ Business Losses/Impacts: # Covered by Total estimated Number Adequate Insurance repair cost Minor Damage (less than 40%) $ Major Damage (greater than $ 40%) Totals $ How many businesses have ceased operations: _______________________ How many businesses have experienced economic injury: _______________ Estimated number of persons unemployed because of this disaster_________________________________ (Contact affected businesses and the local Texas Workforce Commission Office) PUBLIC ASSISTANCE NOTE: All disaster related costs should be separated into the seven damage/work categories listed below: No. of Estimated Anticipated Category Subcategory Sites Repair Costs Insurance * Debris Clearance $ $ Emergency (EMS, Fire, Police) $ $ Road & Bridge Roads - Paved $ $ Roads - Unpaved $ $ Bridges - Destroyed $ $ Bridges - Closed & Repairable $ $ Bridges - Damaged & Serviceable $ $ Culverts - Totally washed away $ $ Culverts - Damaged & still in $ $ place Water Control Facilities $ $ (Dams, levees, dikes) Buildings & Equipment $ $ Public Utility Systems $ $ (Gas, Electric, Sewer, Water) Other $ $ (Recreational Facilities, Airports, etc.) Totals $ $ * Anticipated insurance is normally calculated by subtracting any deductible, depreciation or uncoverable loss from the estimated repair cost. TDEM-93-Page 2 (Rev. 5/10) Total annual maintenance budget (i.e. Public Works, Road & Bridge): $__________________________ Start of Fiscal Year: Month____________ Others (Contact non-profit or governmental, medical, emergency, utility, educational, custodial care facilities, etc.) No. Estimated Anticipated Organization/ Facility of Repair Costs Insurance * Sites $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Totals$ $ This form is for damage assessment reporting purposes only. In accordance with the State Emergency Management Plan, if a Mayor/County Judge determines that a situation is of such severity and magnitude that an effective response is beyond the affected jurisdiction’s capability to recover, a letter outlining the disaster impact and the need for supplemental State and/or Federal assistance must accompany this DSO. Once this form is completed, submit pages 1-3 to your local Disaster District Committee, and to: Texas Department of Public Safety Governor’s Division of Emergency Management P.O. Box 4087 Austin, Texas 78773 or FAX to: 512-424-2444 TDEM-93 - Page 3 (Rev. 5/10) RESIDENTIAL LOSS GUIDELINES Affected: Structure is habitable. Some minor damage may be eligible for assistance. Look for the following: few A missing shingles; Some broken windows; Damage to cars; Damage to Air Conditioner Compressor only; Single Family/Multi Family Residences - 0” - 6” of water Mobile Homes- Ground level to within 12” of bottom board. Minor: Structure is habitable with minor repairs. Look for the following: Many missing shingles, broken windows and doors; Siding loose, missing or damaged; Minor shifting or settling of foundation; Damaged septic systems (flood); Single Family/Multi-Family Residences – 6” to 18” of water, Mobile Homes- Within 12” of bottom board to 3” above floor level. Major: Structure is currently uninhabitable and extensive repair is required to make it habitable. Look for the following: Portions of the roof, including decking, missing; Twisted, bowed or cracked walls; Penetration of structure by trees or cars, etc.; Single Family/Multi Family Residences - 18” – 48” of water, Mobile Homes – 3” – 12” above floor level. Destroyed: Structure is permanently uninhabitable and can not be repaired. Look for the following: Structure gone, only foundation remains; Major sections of walls missing or collapsed; Entire roof gone with noticeable distortion of the walls; Structure has shifted off of its foundation; *Single Family/Multi-Family Residences - More than 48” of water; *Mobile Homes - over 12" for mobile homes. *requires further investigation Estimating Insurance : The following are general guidelines to estimating insurance coverage. Renters are less likely to have insurance. Low income residents are less likely to have insurance. Homeowners who are still paying off their mortgage will normally have the appropriate type of insurance. Residents who are flooded and reside in an area that does not participate in the NFIP or in an area that has been sanctioned for NFIP code enforcement violations will not have flood insurance. Residents who are flooded but whose property is not located in the Special Flood Hazard Area (SFHA) will probably not have flood insurance. TDEM-93 - Page 4 (Rev. 5/10)