JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Hurricane Ida Neighborhood Assessments -Residents
Damage assessments completed by St. Bernard Residents
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Cell phone number
*
Your answer
Address - Use Nearest to Reported Incident. (This could be your home address)
*
Your answer
Community
*
Arabi
Chalmette
Meraux
Violet
Poydras
Caernarvon
St. Bernard
Toca
Kenilworth
Verret
Reggio
Delacroix
Ycklosky
Shell Beach
Hopedale
Required
Road Type
*
Local Road
St. Bernard Hwy
Judge Perez Dr
Paris Rd
LA Hwy 46
Bayou Rd
Type of Damage
*
Tree down
Tree on structure
Structure damage major - damage to roof or wall framing, fire damage
Structure damage minor
Roof damage
Fence damage
Street Signage damaged
Sewer backup
Not applicable
Entergy issue - power line or pole
Required
Tree Issues
*
Tree on public property
Tree on private property
Not Applicable
Entergy Response Needed
*
Power line down
Power pole down or damaged
Power line or pole blocking the street
Power pole on structure
Not applicable
Required
Debris Pile (not trees, appliances and other household items and misc. trash)
*
Yes
No
Additional comments
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
