Primary Residence Damage Assessment Form

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Fill this form out one time for each location where damage occured. Do not combine locations into one form.

If you are needing to report damage to a secondary house or rental property, please click here.

If you are needing to report damage to a business, please click here.

Name*

Physical Address*

Do you Own or Rent this location?*

County Assessed Structure Value

Estimated Structure Loss in Dollars*

Estimated Personal Property Loss in Dollars*

Primary Cause of Damage*

If you have insurance, what is your deductible?

Is the location habitable?*

Is the location Accessible?*

Category of Damage*

Description of Damages

Contact Name*

Contact Phone*

Contact Email*

When did the Damage occur?*

Have you completed the debris removal process?*

This is the first step and will help support Grays Harbor County’s request for aid at the state and federal level. We do not know yet if we will receive any aid, but this helps support our request. In the meantime, do not delay clean up and repairs. Be sure to take pictures of your losses, including the water line with a point of reference, take video if it’s helpful, and keep all photos, videos, and receipts for potential future claims with state and federal agencies. If you also have additional damage to report for a business location, a rental property that you own, or a vacation home, please return to the main page and submit an additional form. For assistance with needs, call Grays Harbor County Emergency Management (360) 249-3911