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Teaneck Isaias Assessment
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* Indicates required question
Name
*
Your answer
Address
*
Your answer
Email
Your answer
Phone
Your answer
What issues are you experiencing as a result of the storm?
*
You may check more than one
Downed Tree
Downed Branches/Tree Limbs
Downed Wires
No Electricity
No Internet
No Cable
Other:
Required
If you selected that there are downed Trees, Branches, and/or Wires, where are they? Check all that apply.
On my property (Front & Back Yards, house, etc)
Sidewalk/street
Other:
If you lost power, since when did you lose power?
MM
/
DD
/
YYYY
Did you lose power AFTER the storm (the next days)
Yes
No
Clear selection
If you lost power after the storm, what day was it?
MM
/
DD
/
YYYY
Has your power been restored?
Yes
No
Clear selection
If your power has been restored, what day was it?
MM
/
DD
/
YYYY
If there are any other issues, please let us know!
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