TOWNSHIP OF GREEN BROOK PRELIMINARY DAMAGE ASSESSMENT- RESIDENTIAL

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This survey is at the request from NJ Office of Emergency Management (OEM). It helps them get a picture of what damage has occurred to individual dwellings.

NOTE:
1. This does NOT take the place of residents working with their private homeowners/renters insurance companies. Likewise this survey and your responses have nothing to do with insurance nor the dollar value to the damage assigned therein.
2. Responses will be kept confidential and will only be sent on to NJOEM
3. This is not mandatory for residents but encouraged.

This is a tool used by FEMA to gather information about the extent of the damage and will help the county and state get the right dollar amounts allocated to different programs. The data collected would support potential federal declaration requests to FEMA for programs like the Individuals and Households Program (IHP) which provides financial and direct services to eligible individuals and households affected by a disaster.

If you should have any questions about this survey, please do not hesitate to reach out to the Township at admin@greenbrooktwp.org or 732-968-1023 x6602. If you would rather fill this form out on paper, you can either print it and drop it off at Town Hall (111 Greenbrook Road) or you can come to Town Hall and fill it in. Thank you!

Last Name, First Name *

Email Address

Phone Number

Address of Affected Property (House/Dwelling #, Street Name, Unit/Apt #) *

Type of Structure *

Single Family (Primary Residence)

Multi Family/Apartment (Primary Residence)

Not Primary Residence

Basement *

Yes, Finished

Yes, Unfinished

Required

Homeowners/Renters Insurance *

Yes

Flood Insurance *

Yes

Brief Description of Damage to Dwelling - What Was Damaged? (ie. roof, finished basement, kitchen, # of bedrooms) DO NOT include personal property *

Conventional Home: Flood Water (Select only one description that describes the level of flood damage that most impacts the living space) *

None/NA

Water in crawl space or unfinished basement (with no damage to mechanical components)

Waterline in finished basement or first floor (main) living space

Waterline up to 18" in first floor (main) living space

Waterline above 18" in first floor (main) living space

Waterline on first floor when basement is completely full

Waterline at roofline or higher

Conventional Home: Other Damage (Select only one description that describes the level of damage that most impacts the living space) *

None/NA

Cosmetic damage (paint discoloration; siding; gutters; screens)

External damage (porch; carport; garage; outbuilding; retaining walls; landscaping; downed trees not affecting access to home)

Damage to mechanical components (furnace; boiler; water heater; HVAC; etc.)

Damage or disaster-related contamination to private well or septic system

Non-structural damage (roof; interior walls; exterior components; small vertical cracks in foundation; chimney)

Structural damage (partial/full failure of roof [rafters; joists; ridge boards; etc.] walls; framing or foundation [crumbling; bulging; collapsing or horizontal cracks > 2 inches])

Irreperable damage (only foundation remains; failure of 2 or more structural components [basement walls; foundation; walls; roof] or confirmed imminent danger)

Estimated amount of Damage ($) - not including personal property *

Estimated amount of Personal Property Loss/Contents ($) - not including loss to physical dwelling *

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