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2. Damage Report - 2025/2026 Winter Flood

   Please provide information regarding damages related to the 2025/2026 winter flood events. This information can aid the county and those affected in their recovery efforts. This is not an insurance form. You will not be compensated for damages by filling out this form.

4. First Name*
5. Last Name*
7. 1. Where in Humboldt County do you live?

   1. In an incorporated city
   2. Unincorporated county
   3. Tribal land
8. 1a. Which community do you live in?
9. 1b. What is your primary address?*
11. 1c. Are you reporting for your home or business?

    1. Home/Residence
    2. Business/Workplace
12. 1d. List the address of the location where damages occurred if different from your primary address. *
13. 1e. Do you have flood insurance?*

    1. Yes
    2. No
15. 2. Did your home or workplace experience structural damage?
17. 3. Did your home or workplace experience a loss of power?
19. 4. Do you smell gas inside your home or workplace?

    If yes, please follow this link to make a report to PG&E: https://www.pge.com/en_US/safety/report-emergency/gas-leak.page

20. 5. Were you injured as a result of the flood?
22. 6. What damages did your home or workplace sustain?
24. 6a. Upload Photo of Damages
25. 6b. Upload Photo of Damages
27. 7. If you own or run a business, how was it impacted?

    1. We had to close.
    2. We operated without power.
    3. We operated on generator power.
    4. We lost revenue as a result of the floods.
    5. We did not lose revenue as a result of the floods.
    6. N/A

    Select all that apply

29. For items 9 through 11, please indicate business revenue, personal income, and other financial losses or storm-related expenses below.
31. 9. Approximate amount of lost business revenue:
32. 9a. Description/type of revenue identified in item #9:
34. 10. Approximate amount of lost personal income:
36. 11. Personal/household financial losses or extraordinary expenses due to the floods (lost food, child care costs, equipment and supplies):
37. 11a. Description of expense type identified in item #11.
39. 12. What communications and data systems were unavailable to you during the flood? (Check all that apply.)

    1. Cell phone service
    2. Land line service
    3. Internet
    4. None
41. 13. Please select the most accurate statement about your household’s disaster preparedness.

    1. My household is very prepared for disasters and extended loss of critical services.
    2. My household is somewhat prepared for disasters and extended loss of critical services.
    3. My household is not very prepared for disasters and extended loss of critical services.
    4. My household is not at all prepared for disasters and extended loss of critical services.
43. 14. Please select all that apply:

    1. My household would like to be better prepared for disasters and extended loss of critical services.
    2. My household doesn’t know how to prepare for disasters and extended loss of critical services.
    3. My household cannot afford disaster preparedness supplies.
    4. One or more members of my household would participate in local community disaster preparedness training if it were available.
45. 15. What steps, if any, will your household take to prepare for emergencies in the future?
47. 16. What steps, if any, will your business or workplace take to prepare for emergencies in the future?
49. If you would like to be contacted to take part in local community preparedness training, please leave your email address below.
51. Sign up for Humboldt Alert
    If you have not already done so, please sign up for Humboldt Alert to receive emergency messages targeted for your area.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

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