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.
Email address *
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.)
Property Ownership
Clear selection
Is the Property Insured?
Clear selection
Other Comments - Notes
I need immediate assistance from the Wylie Emergency Operations Center
Clear selection
Property Type; *
For Businesses or Other Properties:
Complete this section if you are a business
Name of Business or Other Property
Has your Business Ceased Operations?
Clear selection
Best Option on Amount of Damage to Business
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Estimated Amount of Revenue Lost Due to Storm
How Many Employees Does the Business Employ
Is the Business Open or Closed?
Clear selection
What Do you need to Open? (Check all that Apply)
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