Wylie Emergency Operations Center Community Losses / Impact Reporting
Please complete this form so we can gain a better operating picture of the Winter Weather Disaster. We just need an estimate at this time.
Only 1 response is needed. There is no need to submit multiple responses.
Household or Business Name (ex: Smith Residence, etc.)
Address of Home or Business (Number and Street, Suite) (Ex: 1401 N. Ballard)
City, State, Zip Code
Primary Contact Name:
Primary Contact Phone Number:
Primary Email Address:
Check all that Apply as of RIGHT NOW. (For instance, if the power is restored, then don't check Electricity is Intermittent.)
No Problems at All
No Running Water
Electricity is Intermittent - (Example: Rolling Blackouts)
No Electricity at All Since Sunday 2-14-21
Water Damage in House / Business (Sheetrock, floors, personal belongings)
Pipe Burst - Not Repaired
Pipe Burst - Repaired
All Water Has Been Shut Off At Valve
(For Business) Fire Sprinkler System has been Shut Off
I own this Property
I rent / lease this Property
Is the Property Insured?
Yes - The Property is Insured
No - The Property or Business is Not Insured
Yes - I have Renters Insurance
Other Comments - Notes
I need immediate assistance from the Wylie Emergency Operations Center
This is a House
This is a Apartment
This is a Business
For Businesses or Other Properties:
Complete this section if you are a business
Name of Business or Other Property
Has your Business Ceased Operations?
Yes + or - 7 days
Yes + or - 10 days
Yes + or - 14 days
Yes + or - 21 days
Best Option on Amount of Damage to Business
Minor Damage Suffered - Will be operational in a Week from 2/18/21
Major Damage Suffered - May take Longer than a Week from 2/18/21
Estimated Amount of Revenue Lost Due to Storm
How Many Employees Does the Business Employ
Is the Business Open or Closed?
What Do you need to Open? (Check all that Apply)
Need Power On
Need Heat and AC Repaired
Need Water Pipes Repaired
Need Water Restored
Need Fire Sprinkler / Alarm System Repaired
Need Supplies (ex - Restaurant needs food supply)
Need Roads Cleared
Need Nothing - We Will be Ready to Open when the Weather Clears
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