Online Survey Software | Qualtrics Survey Solutions

Please use this form to document impacts from the recent winter storm. Only include impacts that occurred on or after February 11th, 2021.

Please provide your contact information

Your name

Your email address

Your telephone number

Your department or unit

Please select the county that the damaged infrastructure or equipment is in.

Please enter the building information for the damaged infrastructure/equipment.

Building name

Building number (if known)

Room Number

Damage to Infrastructure