On-Line Emergency Assistance Request FormRequest SES Assistance For flood or storm assistanceStep 1 of 1010%Who needs assistance?*MeSomeone ElseTheir Name:*Your Name:*Their Phone:*Your Phone:*Your Mobile:*Your Email:* Enter your postcode:*Enter your street name:*Unit/House Number*Lot Number:Building or Property Name:Please select the property type:*ResidentialMedical FacilityCommercialOtherOther property type:*Are there any special circumstances that prevent the resident from affecting their own repairs?YesNoChoose one of the mentioned circumstances:* Medical Condition Aged Lack of equipment Injured OtherOther circumstance:What is the nature of the damage?* Structural (Damage to walls, windows and roofs of living areas.) Tree down Flooded OtherFor issues with fallen power lines, please call your energy provider. For all other issues, please call 132 500.Other nature of the damage:What areas are affected by the damage?* Living areas (Bedrooms, lounge, dining, kitchen.) Driveway Other areaOther area affected by the damage:How many storeys does the affected building have?*One (1)Two (2)Three or more (3+)What type of roof does the building have?* Tiles Metal Fibro OtherOther type of roof:Are there any hazards that would affect SES volunteers from accessing the building?* Dogs Fibro/asbestos Power Lines Other NoneNote: For issues with fallen power lines, please call your energy provider.Other hazard that would affect SES volunteers from accessing the building:Is there anything else we should know?Δ 2015-12-04SES Team
SES Hedland Hedland State Emergency Service 
