Flood Prevention Planning Questionnaire

2. First Name*
3. Last Name*
5. E-mail*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Address of Flooding Same as Above?

    1. Yes
    2. No
15. If No, Please Enter Address Where Flooding is Occurring
17. Address
19. City
20. State
21. Zip Code
23. Phone Number
25. May we contact you?

    1. Yes
    2. No
27. How do you prefer to be contacted? If by phone, provide the best time to call.
29. Have the streets in your neighborhood ever flooded?

    1. Yes
    2. No
31. If Yes, please provide the typical duration of the street flooding.
33. Has your property ever been flooded?
    -- Select One --YesNo
35. How long have you owned or lived at this address?
    -- Select One --YesNo
37. In the worst flooding of your property, did you receive any warning?
    -- Select One --YesNo
39. If you received warning, from what source?

    1. Media (Radio/TV)
    2. Social Media
    3. Law Enforcement/Emergency Personnel
    4. State Emergency Services SES
    5. Neighbors, Relatives, or Friends
    6. Other

    Select all that apply.

41. Please specify the date(s) of flooding?*
43. What locations on your property were flooded?

    1. Crawl Space
    2. In Home Over Finished Floor
    3. On Land Only
    4. Driveway
    5. Street

    Select all that apply.

45. How many inches of water were present?
47. Were roads in your neighborhood flooded at the time your property flooded?

    1. Yes
    2. No
49. How long did it take for flood waters to recede to a manageable level?
51. Have you installed any flood protection measures on your property?

    1. Sump Pump
    2. Overhead sewers, backup valve
    3. Waterproofed walls
    4. Regraded property to keep water away from building(s)
    5. Backup power system/generator
    6. Sewer Plug or standpipe
    7. Moved things out of the basement
    8. Other

    Select all that apply

53. If other, please explain
55. How would you classify your flood experience(s)?

    1. Nuisance: Water stayed on your lawn/yard for less than 3 days
    2. Prohibitive: Water entered the home or stopped you from entering the home or vehicle
57. Do you have photo or video records of the flooding?

    1. Yes
    2. No
59. If Yes, please upload your photo or video.
61. Please include any additional comments:
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

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