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Welcome to the Municipality of Bethel Park, PA, Action Line
Today is Thursday, June 5, 2025.
WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.
Disaster Damage Report for Businesses

Please use this form to report business damage that you have received from a disaster. PLEASE NOTE: This form is to be used to report damages to the Bethel Park Emergency Management Agency in order to estimate property damage in Bethel Park. This is not a claim form and no reimbursements or payments of any kind will be made based on this report.
Please do not use this form to submit damages from flooding--use the flood report form.

* Information is required.

Contact Information

* First Name:
* Last Name:
* Business Name:
* Email:
* Daytime Phone: ()  –
Fax: ()  –
* Address:
* City:
* State:
* ZIP:

Issue/Problem Location:

* Address
   
- Or Other Not Listed -

Invalid Address

The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue.

The address you entered
 
Unit: 
  Provide any additional information on problem location in the box below.

* Select all statements that would describe your business and/or apply to the disaster.



9
 
* Date Damage Occurred
 
* Cause of Damage





11
 
* Do you own the property or rent it?
 
Do you have insurance coverage for the damage? Select all insurance coverage that you have that may cover this damage.

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* Does your business have more than one location, whether it was affected or not?
 
* Did you lose 40% or more of the value of the contents of your business? Contents include inventory, machinery, and equipment, furniture, fixtures, and supplies.
 
* Select all of the damaged parts of your business: (Please ignore the numbers.)





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* Please describe the damage to your business and what all contents were destroyed.
 
* Is your business closed or severely impacted because of the disaster? If so, do you have an estimate of how long it will take until you return to normal?
 
* Please select all public utilities that are NOT working at your business.


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If there is anything else you would like us to be aware of please list that here:
 
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Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
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