Emergency Management Organization

Community Impact Assessment

After a disaster, Manitoba EMO requires information to determine the impacts on your community. This is necessary to

evaluate the immediate assistance that might be required, and
to begin evaluating the possibility of Disaster Financial Assistance (DFA).

Manitoba EMO requests communities complete the Community Impact Assessment (CIA) below as soon as possible after the event. Whoever has the best knowledge of the damages can complete the CIA. This will typically be municipal Public Works staff, the Municipal Emergency Coordinator, or other municipal staff. The longer communities wait to complete their CIA, the harder it is to re-construct what has happened. The CIA is only a preliminary assessment of damages. It can be modified or updated, and it will become more detailed once the community has carefully inspected damages.

A CIA is critical to determining if a DFA program will be established and should be prepared accurately and submitted as soon as possible; the CIA helps Manitoba EMO to determine the scale and scope of the disaster event.

The information communities provide in their CIA does not limit or determine the level of DFA assistance that might be made available and it should not be taken as an indication that DFA will be provided.

Your information will be treated as confidential and will only be used internally by Manitoba EMO.

Complete a Community Impact Assessment:

Enter information in the form below, or
Download the form. Fax, email or mail the completed form to Manitoba EMO.

Should you have any questions about the Community Impact Assessment, please contact us.

Items marked with asterisk (*) are required to submit the application.

Local Authority Information

Local Authority*:
Contact Person Name:
Position/Title:
Email:
Phone Number:
Alternate Contact Name:
Alternate Position/Title:
Alternate Email:
Alternate Phone Number:

Event

Type*:	(e.g. flood, heavy rains, wind storm, etc.)
Date of event *:	(yyyy/mm/dd)
Description:

Pre-emptive actions and activities (evacuations, diking, etc.)

Number of persons evacuated:
Evacuation start date:	(yyyy/mm/dd)
Evacuation end date:	(yyyy/mm/dd)
Pre-emptive actions (briefly describe actions taken to prevent or reduce damages):

Damages

Private Property (Private Sector)

	Minor Damage	Major Damage	Destroyed
Number of Homes:
Number of Farm Operations:
Number of Businesses:

Describe damages (e.g. basement and/or main floor flooding, wind and rain damages, fire losses, etc.):

Public Property (Public Sector)

Damage to Buildings (owned by local authority)

Building and damage description (include the building description (use) and description of damage to each building):

Municipal Infrastructure (Public Sector)

Number of bridges damaged:

Minor:
Major:
Destroyed:

Engineer Reports or contractor estimates:

Number of site(s) that require engineer reports or contractor estimates:

Total number of damaged sites:

Total number of all damaged sites (bridges, road washouts, culverts and drainage system damages):

Estimated damages:

Total estimated cost of all damaged sites:
$

Insurance:

Are any public sector damages covered by your insurance policy?

If yes, have you contacted your insurance provider?

Mitigation and Preparedness Program:

Do you plan to opt into the Mitigation and Preparedness Program?

Comments and Additional Information

to EMO or

to reset

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