Form 1

DISASTER FLASH REPORT

Date:
Time:

Origin of Report:

1. Profile of the Incident:

What:
(Type of disaster)
When:
(Date and Time of occurrence)

Where:
(Estimated location)
Why:
(Probable cause of incident)

Who:
(Number of affected population and responding agencies in the area)

How:
(How was the response carried out?)

Is there a need for:

Search and rescue assistance? __ _ YES _____NO

Evacuation? ____ YES _____NO

Signed: ______________
PDRRMC Chairman
FORM II
Rapid Damage and Needs Assessment Checklist
(To be submitted within 6 hours upon occurrence of disaster)

I. Objectives:
 To obtain an initial assessment of the impact of the disaster
 To know the immediate response undertaken at the local DRRMC level
 To determine the additional requirement for follow-up response
 To serve as basis foe decision-making at higher level
 To serve as basis for future plans

II. Profile of the Disaster

 Type of disaster/ emergency ________________________________________
 Date and time of occurrence ________________________________________
 Areas affected ___________________________________________________
 Sources of reports ________________________________________________
 Date and time of reports ___________________________________________

III. Initial Effects:

1. Estimated no. of affected population: _________ Families _________Persons
2. Estimated no. of displaced population: ______________Families___________Persons
No. of infants __________________________ (0-2 years old)
No. of children _________________________ (3-12 years old)
No. of adolescent _______________________ (13-17 years old)
No. of adults ___________________________ (18 years old above)

3. Estimated Casualties: Location Number Cause

Dead __________________ ____________ __________
Injured __________________ ____________ __________
Missing __________________ ____________ __________

IV. Needs Assessment

1. Is there a need for immediate assistance? yes ______________no

2. What are these needs? (check priorities)

 Priority 1 – (search and rescue, evacuation, health and medical, clothing, food, shelter, water,
restoration of lifelines and sanitation)

Priority 2 – (transport, logistics storage, security and communications)

Priority 3 – (social services, reconstruction of damaged facilities and economic recovery)

3. Restoration of Damaged Lifelines:

Exact locations
_________________________________________________

Condition of damaged systems

_____________________________________________________________________
 (i.e. operational, non operational, totally/partially damaged)
Enumerate the needs according to priorities ______________________
(i.e. immediate repair, restoration by service provider)
Eroded – boundary Conception-Balili
Initial actions and the local level

_____________________________________________________________________

4. Medical and Health:

Exact locations

Estimated no. of injured persons

Estimated no. of displaced families or persons that need medical attention

No. of families___________ No. of persons 21 children Requirements needs according to
priorities ____________________________________

(i.e. medicines, medical supplies and others (specify)

5. Food, Water, Clothing and Shelter:

Exact locations

Name of evacuation centers

Estimated no. of families or persons housed in evacuation centers
families______________________________________________________

Estimated no. of families or persons in need of assistance

families_____________________________________________________________

Estimated daily requirements of affected families in evacuation centers

_________________________
Signed: PDRRMC Chairman

FORM III
 Damage Assessment Form
(To be submitted within 12 hours upon occurrence of disaster)

Type of Disaster

Date and Time of Occurrence

Source of Report

1. Description of the Affected Area

Rural ___________________________ urban _____________________________
Densely populated sparsely populated __________________
Commercial _____________________ residential ____ _____________________
2. Damaged Structures
2.1 How many units were destroyed? _________________________________________
Breakdown Totally Partially Est. Cost
(Number) (Number)

Schools _______________ __________ ____________

Hospitals ___________ __________ _____________
Government offices ___________ __________ _____________
Public markets ___________ __________ _____________
Flood control (sea walls/ _______________ __________ ____________
dikes/dams/irrigation systems)
commercial facilities ___________ __________ _____________
(factories/malls/stores/supermarkets)
Other (specify) ___________ __________ _____________
Canal

3. Affected Lifelines
3.1 Transportation facilities
Roads Location Passable/Not passable No. Est. Cost
National ________ _________/____________ ________ ___________
Provincial ________ _________/____________ ________ ___________
Municipal ________ _________/____________ ________ ___________
City ________ _________/____________ ________ ___________
Barangay ________ _________/____________ ________ ___________
Bridges ________ _________/____________ ________ ___________
BAILEY ________ _________/____________ ________ ___________
Concrete ________ _________/____________ ________ ___________
Wooden ________ _________/____________ ________ ___________
Railways ________ _________/____________ ________ ___________

Location Operational/ Non Operational No. Est. Cost

PLDT ________ _________/____________ ________ ___________
Bayan Tel ________ _________/____________ ________ ___________
Others ________ _________/____________ ________ ___________
Cell Sites ________ _________/____________ ________ ___________
Radio repeaters ________ _________/____________ ________ ___________
3.2 Was there power interruption? __________ yes _________________ no
_________________date and time _______________________________________ problem cause
Is it widespread or concrete in one area? ____________ yes _________________ no
Are there electric posts toppled down? ______________ yes ___________ no
How long will it take before the service is restored? ______________ No. of days
 3.3 Actions taken by the servicing companies ______________________________________

3.4 Is there water shortage? ___________ yes __________ no date ___________________

Is it widespread or concentrated in one areas? ___________ yes __________________ no

3.5 Are there alternate sources of water? ____ yes ________ no if yes, specify ____________
_________________________________________________________________________________

___________water
system_______________________________________________________________

3.6 Did the service provider took immediate repairs? Yes_________ no ____________ if yes, how long
will it take to restore the systems? Number of days ______________
4. Agriculture
IV.1 Determine the damage of crops, live stocks and fisheries in terms of the following indicators:

4.1.1Crops

Areas Damaged Losses No. of Hectares (Metric Tons) (Peso Value)

Rice _____________________________________________________________
Corn _____________________________________________________
Vegetables _____
____
Root Crops ___________________ _________________
Fruit Trees ___________________ _________________
Banana ___________________ _________________
_______________
Others ___________________ _________________
_______________

4.1.2 Fisheries
Fishponds ___________________ _________________
Fishing boats (Number) _______________ _________________

4.1.3 Livestock’s
Animal No. of Heads Pesos Value
Farm Animals _____________ _____________

Poultry and fowls _____________ _____________

4.2 Are prime commodities locally available? ___________ yes ____________ no

Progress report follow

_________________________
Signed: PDRRMC Chairman