American Red Cross 5739A Detailed Damage Assessment Supplemental Worksheet
DR #:
:drnbr:		 DR Name:
:drnam:		 State:
:state:		 County:
:cnty:		 City/Community:
:city:		 Date:
:date:
Street Name: :street: Geographic Reference: :georef:
Address Range:
Primary Dwelling Type: :dwell0:
Basements Prevalent?: :base0:
 Approximate
number of
dwellings/units in
this range of
addresses:
Description of Damage
Destroyed:
Major:
Minor:
Affected:
Inaccessible:
Unknown/None:
 :ds0: %
:mj0: %
:mn0: %
:af0: %
:in0: %
:un0: %
or general description:
:gd0:
Address Range:
Primary Dwelling Type: :dwell1:
Basements Prevalent?: :base1:
 Approximate
number of
dwellings/units in
this range of
addresses:
Description of Damage
Destroyed:
Major:
Minor:
Affected:
Inaccessible:
Unknown/None:
 :ds1: %
:mj1: %
:mn1: %
:af1: %
:in1: %
:un1: %
or general description:
:gd1: