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Flood Damage Questionnaire

  1. Village of Skokie - Flood Damage Questionnaire
    The purpose of this questionnaire is to help the Village of Skokie identify areas with flooding problems. Although completing this questionnaire is voluntary, your response will help in the engineering study to determine potential solutions to the flooding problems.
  2. 1. Is your property:
  3. 4. If flooding occurs on your property, where is the primary location(s)?
  4. 7. Flooding in your home occurs from what source? (see figure below)
  5. Flood Damage Photo
  6. 9. Are you participating in the National Flood Insurance Program?
  7. 10. Do you have an insurance rider for sewer backup?
  8. 11. If you have had structure flooding, please describe the extent of flood damage that has occurred (including the date, depth of the water, duration of the flood (hours), and value/content of damage to your building).
  9. (Date)
  10. Please indicate what floor (basement, first floor, etc.)
  11. (Hours)
  12. Please specify if it was building damage or content
  13. (Date)
  14. Please indicate what floor (basement, first floor, etc.)
  15. (Hours)
  16. Please specify if it was building damage or content
  17. (Date)
  18. Please indicate what floor (basement, first floor, etc.)
  19. (Hours)
  20. Please specify if it was building damage or content
  21. High Water Mark refers to the peak level reached by the flood waters outside your home.
  22. Leave This Blank:

  23. This field is not part of the form submission.