Urban Flood Impact Survey Form
Urban Flood Impact Survey Form – Please help us understand the effects of recent urban flooding by completing this survey. Your input will support community response and planning.
Location of Flood Impact
*
Date and Time of Flood Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Area Affected
*
Residential
Commercial
Industrial
Public Infrastructure
Other
Observed Flood Depth (approximate)
*
Please Select
Less than 15 cm (6 inches)
15–30 cm (6–12 inches)
30–60 cm (1–2 feet)
Over 60 cm (2 feet)
Unknown
Duration of Flooding
*
Please Select
Less than 1 hour
1–3 hours
3–6 hours
6–12 hours
Over 12 hours
Unknown
Select All Impacts Experienced
*
Property damage
Road closures
Power outages
Water contamination
Displacement
Other
Rate the Severity of the Flood Impact
*
1
2
3
4
5
Community Response Observed
Emergency services present
Volunteers assisting
Evacuation carried out
No response observed
Other
Please indicate accessibility after flooding
*
Fully accessible
Partially accessible
Not accessible
Unknown
Additional Comments or Upload Photos (optional)
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