FLOOD INFORMATION REPORTING FORMAT Report Date: Enter your information below Agency/Organization reporting Person Reporting Contact telephone number(s) Contact email River flooding (yes/no) * Flash flooding (yes/no) ** Date of river flooding Region / District(s) Name of Towns/Villages flooded Location of the area according to Reference Grid provided Planted crop fields flooded (yes/no) Number of households in flooded area Number of households displaced If households displaced, where are they? Livestock deaths (yes/no), If yes number? Any other relevant information? * River flooding definition: The rise of a river to an elevation such that the river overflows its natural banks ** Flash flooding definition: Flooding that develops very quickly on streams and river tributaries