Business damage report

        Business Name
        
        Type of business
        
        Business Owner Name
        
        Business Contact Name
        
        Business Contact Phone
        
        Business Contact Email
        
        Business Location: Street Address, City, ZIP Code
        
            Is facility rented or owned?
 
        If facility is rented, list facility owner contact name and information, if known
  
        Degree of Damage
        
        Estimated Pre-Disaster Fair Market Value of Business (best guess of building value before damages)
        
        Estimated Structure Loss (estimated monetary damages to facility)
        
        Estimated Dollar Loss Furnishings/Inventory (estimated monetary loss of inventory and contents – including tenant improvements) 
        
        Estimated economic activity loss (estimated loss of revenue from closure) 
        
        Primary Cause of Damage

        Description of damages (structure, contents)
        
Date Damage Occurred
            Date
  
  Day (Number)
  
    Year
  
  Hour
  
    AM/PM
  
        Type of insurance
        
  Civil unrest insurance or rider (yes/no)

        Deductible amount
        
        Amount of insurance coverage for facility (if known)
        
        Amount of insurance coverage for contents (if known)
        
        Number of days closed due to disaster
        
  Do you have Business Continuity Insurance?

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Business damage report

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Business damage report

Business damage report

King County Emergency Management