Horticulture Industry Network - Flood Assessment 2011

Thank you for your time.

We will refer your needs to those who can assist you and the information provided will help government and industry groups plan longer term recovery programs.

If you have concerns you can contact Mark Lee at DPI on (03) 5336 6605 or mark.lee@dpi.vic.gov.au, call the Customer Service Centre on 136186 or contact your Industry Association.

Contact details for your Industry Development Staff Member can be found on the HIN Contact Page.

Privacy: Some of the data you provide may be shared with other support agencies, such as the Department of Human Services (DHS), Rural Financial Counselling Services (RFCS) or your Industry Association. For more information on our privacy policy please visit this link.

The Property Owner
Property Owners First Name:
Property Owner Last Name:
Trading Name:
Owners Town:
Owner Post Code:
Owner Mobile Phone No.:
Owner Land Line:
Owner e-mail address:
The Manager (If different from above)
Manager First Name:
Manager Last Name:
Managers Town:
Manager Post Code:
Manager Mobile:
Manager Land Line:
Managers E-mail:
The Property Location
Property Shire (local Government Area):
Property Parish (optional):
Description of Property Location (i.e.; 124 Campbell St):
Property Number (shire/grazing):
Link to Google Map:
Total Farm Area (Ha):
The Loss & Damage
Percentage (%) Inundated:
Number of Houses Lost:
Poly, Green or Glass House Lost (Ha):
Bird, Hail, Shade Netting Lost (Ha):
Number of Pump Shed, Stations Lost:
Number of Pumps Lost or Damaged:
Number of Mahinery Sheds Lost:
Trellis Lost (Km):
Fencing Lost (Km):
Pipes Damaged (Km):
Number of Filters Lost or Damaged:
Number of Risers Lost or Damaged:
Number of Valves Damaged:
Channel Damaged (Km):
Area of Orchard Damaged (Ha):
Area of Vines Damaged (Ha):
Area of Citrus Damaged:
Area of Olives Lost:
Area of Vegetables Lost:
Other loss:
The ($) figure for loss is loss incurred by flooding (rising water), heavy rain or loss of access to harvest or perform management tasks.
Value Asset Damage ($):
Value Of Crop Loss ($):
Non Agricultural Needs (Information may be shared with other agencies)
Emergency Housing:
Emergency Transport:
Financial advice:
Food - Water:
Medical Needs:
Personal or family counselling:
Other Urgent Non Agricultural Needs (Please Specify):
Do you have any animal health issues (stock loss, feed)?:
Are there any other comments you would like to provide?:
Other
E-mail address for us to send a confirmation to (required):
I understand the information provided may be shared with other assistance agencies (DHS, RFC etc):