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.
Address & Contact
City of Pembroke
Town of Petawawa
Township of Laurentian Valley
Township of Horton
Township of McNab/ Braeside
Township of Whitewater
Rapid Damage Assessment
Do you have flood insurance?
Yes, and I have contacted my adjuster
Yes, and I have not contacted my adjuster
No, I do not have flood insurance
Does the owner require special assistance? If Yes, please explain.
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.
I understand and consent to the conditions outlined above.
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