Use this sample template to develop a damage and cost report for your utility. This is not an official template for any particular federal disaster funding program. It is based on utility best practices.You may need a PDF reader to view some of the files on this page. See EPA’s About PDF page to learn more.
Full Report Template (PDF)(19 pp, 2 MB)
This template provides blank sections and forms that you can use to enter your utility's damage and cost information. You can create a complete report or only those sections that meet your needs.
Cover Page (PDF)(1 pg, 60 K)
This page is the cover page for damage assessments.
Purpose and Table of Contents (PDF)(1 pg, 58 K)
This page is the purpose and table of contents for damage assessments.
Executive Summary of the Disaster (PDF)(1 pg, 58 K)
This page is the executive summary for damage assessments.
Executive Summary of Damage and Costs (PDF)(1 pg, 58 K)
This page is the executive summary of damage and costs for damage assessments.
Documentation of Damage and Costs (PDF)(1 pg, 58 K)
Attach your logs, forms, spreadsheets, and receipts. The number and order of the forms will depend on the needs or the requirements of the funding program that you are pursuing.
Reference Documents (PDF)(1 pg, 58 K)
Attach supporting materials, such as insurance policy information or maintenance records.
Instructions (PDF)(3 pp, 321 K)
This document provides instruction on how to use the Damage Assessment template.
Completed Report Template on Damage and Costs for Anytown, USA (PDF)(15 pp, 542 K)
Follow this link for a completed report template based on hypothetical damage and costs to a water tower from a hurricane.