Initial Damage Assessment / Windshield Survey

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  Jurisdiction     Mission or Incident #  

     Event      If OTHER; Description    

Survey Area     Survey Team  

  Start Date of Event              Date of this Survey    

Affected
10 %		 Minor
25 %		 Major
50 %		 Totaled
100 %		 Total
Number		 $ Loss 
CATEGORY                                                    # # # # Count $ Estimate
HOUSES
APARTMENT COMPLEX
MOBILE HOMES
RESIDENTIAL HIGH RISE BUILDING 
COMMERCIAL HIGH RISE BUILDING
PUBLIC BUILDINGS
SMALL BUSINESS
FACTORIES / INDUSTRIAL COMPLEX
ROADS
BRIDGES
ELECTRICAL DISTRIBUTION
SCHOOLS
Total Dollar Amount:
COMMENTS (if any by the survey team)

 {var Comments}
     Use your jurisdictions guidelines or these generic suggestions on habitable buildings. On other facilities get direction as needed
AFFECTED: Structure currently habitable. Cosmetic damage e.g. missing shingles. Generally less than $100 in damage. 0 to 6 inches of water in single-family dwelling.  MINOR:  Structure currently uninhabitable. Will require minor repairs to be made habitable. 7 to 24 inches of water in structure and 0 to 6 inches of water in a mobile home.  MAJOR: Structure currently uninhabitable. Will require major repairs to be made habitable. 25 to 47 inches of water in a single-family dwelling or apartment. 7 to 23 inches of water in a mobile home. TOTALED: Structure permanently uninhabitable. Cannot be repaired. 48 or more inches of water in a single-family dwelling or apartment. 24 or more inches of water in a mobile home
                                                                                         Express Sender               Ver 11.5