Submit Damage Assessment

 
Residents with damage to their home or property due to a weather related event may use the form below to report the damage to Santa Rosa County. Once submitted, your information will be sent to several Santa Rosa County Departments including emergency management, public works, floodplain management and grants. Staff will document your information in a damage database, review qualifications for mitigation projects/grants and determine if an additional damage assessment or other action is needed if available. Submittal of this form does not guarantee that your damage will qualify for any assistance or that you will be contacted. This information may also help the county apply for federal assistance which may help pay for repairs not covered by your insurance. Residents may also report damage by calling (850) 983-5360. If you have already begun repairs, be sure to take photos of the damage and keep all receipts for any repairs you make. Make sure the date is clearly visible on all receipts.
 
 
Street Num: Street Name:
Name: Phone:
E-mail Address: Today's Date:
Damage Caused By: Fire  |  Flood  |  Tornado  |  Wind  |  Other
Affected Property: SF: Single Family  |  MF: Multi-Family  |  MH: Mobile Home  |  Biz: Business
Attached Garage  |  Detached Garage  |  Driveway  |  Yard  |  Other
 
Is The Property Accessible: Yes  |  No    
Residence Type: Ownership:
Date Damage Occured: Have You Been Temporarily Displaced:
Insured: (select all that apply) Yes - Owner   |   Yes - Renter   |   Flood Insurance   |   None
Estimated Damage Value: Depth of Flooding/High Water Line: (inches)
 
Notes:
 
Photo Submissions: Unless stated otherwise in the body of your email, by submitting photos to this email address you are granting the Santa Rosa County Board of Commissioners, its employees, designees, agents, independent contractors, legal representatives, and assigns, and all persons or departments for whom or through whom it is acting, permission and right to use the attached photograph/artwork/etc. for publicity, illustration, art, advertising, marketing, or any other lawful purpose. And you acknowledge and understand that you may not receive photo credit or other credit for the photograph/artwork/etc.

I indemnify, release and agree to hold harmless SRC of and from any liability by virtue of use of the photograph/artwork/etc.
 
Please make sure the total size of all picture(s), reciept(s), document(s) are less than 10mb. Please DO NOT submit videos. Please compress your pictures as needed to meet this requirement.
Attachment 1:
Attachment 2:
Attachment 3:
Attachment 4:
 

 

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Copyright 1998, County of Santa Rosa, Florida. All Rights Reserved. Other copyrights apply. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.