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Damage Assessment Reporting Form

  1. Westland City Seal
  2. Please fill out this form if you have water damage or flooding from the storm on June 25 - 26, 2021.

    The purpose of this form is to collect information only for reporting to the State pursuant to Public Act 390 of 1976 and is not mechanism for any other type of reimbursement or financial assistance. 

    This is not a damage claim form pursuant to Public Act 222 of 2001.

    All information provided in this form is subject to Freedom of Information Act requests subject to State law.

  3. Personal Information
  4. Damage Information
  5. Do you have water damage?*
  6. What type of structure received damage?*

    Check all that apply

  7. What level of floor was affected?*

    Check all that apply

  8. If the basement had water damage, does the basement include livable space?*

    Examples:  bedroom, finished basement, etc.

  9. If there was damage to livable space within the building, what percentage of the space is unlivable?*
  10. What is the overall level of damage within the building?*
  11. Insurance Information
  12. Do you have insurance coverage for the structure?*
  13. Does your insurance cover the loss?*
  14. What amount of the loss is covered by your insurance, if applicable?*
  15. Please submit this form by Friday July 2nd, 2021.

    The form can be submitted by:

    • Selecting Submit on this electronic form.
    • Email the completed form to
    • Drop off the form at Westland City Hall located at 36300 Warren Rd, Westland MI, 48185

  16. Leave This Blank:

  17. This field is not part of the form submission.