Recovery Assistance Request - Rapid Damage Assessment - Ottawa River Flooding 2019
This form is to gather information to aid your municipal leaders in planning and executing the recovery from the Spring Floods 2019. Filling out this form is not a guarantee that work will be done on your property, rather the data you provide will be used to help identify priorities for recovery assistance.
Name *
Your answer
Address & Contact
Street Number *
Your answer
Street *
Your answer
Municipality *
Province *
Your answer
Postal Code *
Your answer
Phone Number *
Your answer
Your answer
Rapid Damage Assessment
Structure Type
Primary residence?
Do you have flood insurance?
Does the owner require special assistance? If Yes, please explain.
Your answer
Is the home currently accessible by ground?
Team Rubicon Canada strives to identify the reason for data collection, and
achieve the highest standard to data protection. In submission of this request, the
homeowner acknowledges that information and data disclosed in this form may be
shared with local governments, and other NGOs within the scope of the disaster
response. Homeowner information and data is required strictly for operational purposes
(for example, making contact with homeowners after the reception of an electronic
form). All information and data submitted via this electronic form will be destroyed at the
end of the disaster response.

Any questions about TRC's privacy policy can be sent to .
Never submit passwords through Google Forms.
This form was created inside of Team Rubicon Canada. Report Abuse - Terms of Service