Hurricane Melissa Household Damage Reporting Form – Ministry of Labour and Social Security

Use this form to quickly report damage or losses to your home from Hurricane Melissa. This is an initial record only. An assessor will visit you to collect detailed information. Please provide accurate contact and address details and a brief description of the damage.

You may report damage for someone else.

Name of head of household (Impacted Household)

First Name

Middle Name

Last Name

Alias

Identification

TRN (where available)

Address

Street

Parish

Constituency

Community

Telephone Contact

Telephone1

Telephone2

Telephone3

Comments

Damage received

Additional Feedback

I hereby certify that the information provided in this form is true, complete, and accurate, whether submitted for myself or on behalf of someone else. I understand that this information will be verified by an official assessor.