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National Disaster Response Plan (NDRP) March 2010 - NDMA

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165<br />

Annex H<br />

To <strong>National</strong> <strong>Disaster</strong> <strong>Response</strong> <strong>Plan</strong>-<strong>March</strong> <strong>2010</strong><br />

DAMAGE AND LOSS ASSESSMENT REPORT FORMAT<br />

1. Situation Report: District Government: District <strong>Disaster</strong> Management Authority (Weekly)<br />

Nature of <strong>Disaster</strong>: ------------------ District ----------------- Report--------------- Date----------------<br />

Reported By: ------------------ Telephone ------------------ Time ------------------------<br />

Affected Area: # of families ------- # of Villages --------- # UCs ---------- # of Tehsils/Taluka -----<br />

1. Overall Emergencies Condition N/A --------- Minor --------- Significant ----------- Major ------<br />

2. Casualties (Provide latest Cumulative figures) Fatalities --------- Injuries --------- Missing ----<br />

3. EOC Activation Closed -------------- Alert Stage --------------- Fully Activated-----------------<br />

4. Emergency Orders (Emergency Declared, Evacuation Ordered, Relief Camp set up etc)<br />

_____________________________________________________________________<br />

5. Any support received from:<br />

Police ------------CD ------------- Health ------------ PHE------------PWD ------------ Others -----------<br />

(Describe): ------------------------------------------------------------------------------------------------------------<br />

6. Relief Camp Status: Name/location # of Families Managed by<br />

DDMA/PRCS<br />

Open/Closed<br />

7. Roads/Bridges Status: Blocked ---------- Washed out ---------- Flooded ---------- Closed ------<br />

Give location: --------------------------------------------------------------------------------------------------------<br />

8. Damage Report Minor* # Significant* # Major* #<br />

Houses<br />

Public Buildings<br />

Private Buildings<br />

Water supply<br />

Drainage/Sewerage<br />

Electricity Outages<br />

Telephone Outages<br />

Food Storage<br />

Irrigation Infrastructure<br />

Agriculture Crop Damaged: Type of Crop Damaged --------------- # of Acres ---------------------<br />

Type of Crop Damaged -------------- # of Acres ---------------------<br />

Livestock: # Animals Injured ------------------ # of Animal Died -----------------------------<br />

9. Any Other Vital Information:<br />

10. Specify Immediate Needs: (In Quantity)<br />

Food: ------------------ Medical Supplies: ---------------------------------- Tents -----------------------

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