Collased Structures Rescue Course – Light Level

Damage Assesment Sheet

1. Address and Location

Address City Zip Code

Contact Phone Number of Occupants

Number of floors Use

Residential Industrial
Approx Dimentions Commercial Institutional
Front (Linear M/ft) Educational Warehouses
Side (Linear M/ft) Health Center Parking Lot
Office Building Other
Building Componets
Building Components Floor Dividers
Concrete Wood Concrete slab
Cast Iron / steel Wooden components
Other Any other materials

General Impression

External Damage Total collapse Partial collapse

Damage to Structural Members

Load bearing walls Staircase Electric power
Paricians Natural gas lines
False ceilings Potable water tanks
Other

Structural Components
Columns Concrete slab
Rafts Wooden components
Load bearing walls Any other material

Percentage of damage to the building

None Moderate Severe
Minimal Considerable Total Collapse

Diagram Safety Recommendations

Observations

Nov -07 DM 3-1