Flood and Coastal Storm Damage Surveys

Flood and Coastal Storm Damage Surveys

NonresidentialDamageSurvey_2.1.2021

Flood and Coastal Storm Damage Surveys

OMB: 0710-0017

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OMB CONTROL NUMBER: 0710-0017

OMB EXPIRATION DATE: XX/XX/XXXX


AGENCY DISCLOSURE NOTICE


The public reporting burden for this collection of information, 0710-0017, is estimated to average 30 minutes per survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.



NONRESIDENTIAL


Background Information



  1. Briefly describe the major purpose of this business facility? ________________


______________________________________________________________________


  1. What is the total number of buildings on site _____ Buildings



  1. Number of years business has been at this location _____ Years


4. Please indicate the number of full time, part time, and total employees.

_______ Full Time ________ Part Time ________Total Employees

5. How many shifts are there in your daily operation?

______ Shifts per day

6. While at this location, approximately how many times has this facility experienced flood damage, including the flooding from ­­­­­­­the (date) floods?

_________ Times

7. Briefly describe any permanent flood mitigation measures that have been implemented to reduce potential flood damage.

8. How many days, if any, was this business closed due to the (date) flood?

__________ DAYS CLOSED

8a. Did your business set up temporary quarters at another location because of the (date) floods? (CIRCLE)

1. NO

2. YES

8b. How much additional money did the flood cost your business in increased operational expenses, such as temporary quarters, additional transportation, communications, or storage expenses?

$____________ Total Additional Dollars



8c. Please describe additional costs. ___________________________________________________________________


___________________________________________________________________



Individual Building Information

(Questions 9-21 are to be answered for your primary building only. If there are multiple buildings at the facility, a supplemental sheet is provided that asks for similar information.)



9. Brief description of function of the primary building and its contents:

10. Prior to the (date) floods, what was the value of all equipment

physically attached or anchored to this building, not including

the building itself? $________


11. Prior to the (date) floods, what was the value of all other

equipment, furniture, supplies, raw materials, and inventory

generally stored in this building? $________

12. Prior to the (date) floods, what was the value of all

vehicles generally stored at this building? $________

  1. Prior to the (date) flooding, what was the value of all

other equipment, supplies, and inventory stored outside of,

but in the immediate vicinity of this building? $________



14. Excluding any basement or attic how many stories does this building have?

_______________ STORIES

15. What is the average story height in this building?

_______________ FEET

16. What year was this building constructed? ___________________

17. What is the shape of this building? (Circle one answer.)

1. Square

2. Rectangular

3. L-shaped

4. U-shaped

5. Very Irregular

18. What is the size of your building in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

___________ SQUARE FEET

19. Indicate what type of heating and cooling system is used in your building?

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water


Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System


Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

20. Does this building have a basement? (CIRCLE)

0. NO

1. YES

20a. If yes, please indicate the total basement area, and the area in square feet or dimensions of the area that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

Total Area: ________________ Square Feet

Finished Area: _____________ Square Feet

Unfinished Area: ___________ Square Feet

21. Please indicate the primary construction material for the building frame.

___Block/Brick ___Steel ___Wood ___Metal

(Check appropriate block)

22. Relative to the 1st floor elevation of the building, what is the current value of the contents and where are they located vertically? (up through 1st floor only)

Height (ft)

Equipment ($)

Furniture ($)

Inventory/products ($)













0.0 ft




1.0 ft




3.0 ft




6.0 ft




8.0 ft




Total




Notes to interviewer:

  • Shaded areas are for buildings with a subterranean level only. Please fill in appropriate values for the depth (e.g., -1.0 ft, -3.0 ft, -6.0 ft). Leave shaded areas blank if no subterranean level exists.

  • The values in the columns should be a cumulative total, starting from the lowest level of the structure.







Physical Damage and Other Costs

23. How high in feet and inches did the water from ______ (year) flood reach on the inside of this building relative to the first floor of the building?

______ FEET; _______ INCHES (ABOVE, BELOW) First Floor Level

[CIRCLE]


24. Please estimate the damages to your business from past flooding events. Please give a single set of combined damages for all floors in all buildings.


Date of the flooding event:

__________

Date of the flooding event:

__________

Contents damage estimate ($):

$_________

Contents damage estimate ($):

$_________

Structure damage estimate ($):

$_________

Structure damage estimate ($):

$_________

Number of lost business days:

______Days

Number of lost business days:

______Days

Amount of lost net income ($):

$_________

Amount of lost net income ($):

$_________

Cost of cleanup ($):

$_________

Cost of cleanup ($):

$_________

























25. Please indicate the replacement value and damage or costs that you attribute to each of the following items.






Replacement Value



Actual Damage or Cost



Damage to Transportation









Roads, bridges, streets, walks, parking



$_________



$_____________________




Rail beds and tracks



$_________



$_____________________



Rerouting trains, trucks, cars, & buses



$_________



$_____________________



Docks and loading facilities



$_________



$_____________________



Damage to Buildings









Foundation and supports



$_________



$_____________________



Floors (mark one)

___Steel ___Concrete ___Wood



$_________



$_____________________



Floor covering (mark one)

___Ceramic ___Linoleum ___Carpet



$_________



$_____________________



Exterior walls and insulation (mark one)

___Metal ___Wood ___Block/brick



$_________



$_____________________



Windows



$_________



$_____________________



Interior walls and ceilings



$_________



$_____________________



Doors and moldings



$_________



$_____________________

Damage to Building Utilities

Indicate location: B=Basement, G=Ground floor,

I=Intermediate floors, R=Roof



Replacement

Value



(year)Flood

Actual

Damage or Cost



Sewer systems

___Storm ___Industrial ___Sanitary

___B ___G ____I ___R



$_________



$_____________________



Water supply systems

___Treatment ___Pipes

___B ___G ____I ___R



$_________



$_____________________



Water systems

___Hot water ___Softening

___B ___G ____I ___R



$_________



$_____________________



Communications systems

___B ___G ____I ___R



$_________



$_____________________



Electric power transformers

___Pole ___Ground



$_________



$_____________________



Electrical service entrance and meters

___B ___G ____I ___R



$_________



$_____________________



Engines/generators/alternators

___B ___G ____I ___R



$_________



$_____________________



Other Electrical control panels and circuit breakers

___B ___G ____I ___R



$_________



$_____________________



Wiring switches, outlets, lighting

___B ___G ____I ___R



$_________



$_____________________



Fuel supply

___Oil tanks ___Gas pipes/meters

___B ___G ____I ___R



$_________



$_____________________



Heating

___Oil ___Gas ___Elect. ___Air

___Water

___B ___G ____I ___R



$_________



$_____________________



Air conditioning

___Gas ___Electric ___Cool ___Purify ___Dehumidify

___B ___G ____I ___R



$_________



$_____________________



Damage to Equipment, Appliances, and Furniture









___Conveyors ___Elevators ___Escalators




$_________



$_____________________



Foundry furnaces and welding equipment



$_________



$_____________________



Machine tools and patterns



$_________



$_____________________



Other motors and engines



$_________



$_____________________



Compressors



$_________



$_____________________



Built-in refrigeration units



$_________



$_____________________



Hand and paint tools



$_________



$_____________________



Other equipment



$_________



$_____________________



Display cases, counters, and bins



$_________



$_____________________



Appliances

___Oven ___Refrigerators

___Other _____________________



$_________



$_____________________

Vehicles kept at this location



$_________



$_____________________



Damage to:









Parts/raw materials



$_________



$_____________________



Partly assembled/processed product



$_________



$_____________________



Inventory



$_________



$_____________________



General Costs









Fighting the Flood






$_____________________



Evacuation

___Owner ___Tenant






$_____________________



Number of employees out of work






____________ Unemployed



Value of lost wages






$_____________________



Removal of debris and damaged items






$_____________________



Disinfecting, other cleaning and rehabilitation






$_____________________



Replacement of records






$_____________________



Loss of gross income due to interruption of business






$_____________________



Loss of net income due to interruption of business






$_____________________



Increased alternative operating costs






$_____________________





























26. Please indicate the approximate dollar value of damage from the (date) floods to the following categories:

Structure Damage = Damage to any building components, including foundation, walls, floors, doors, windows, roof, electrical system, heating and cooling systems, plumbing, attached carpeting, attached shelves and cabinets, and built-in equipment and appliances.

Content Damage = Damage to unattached equipment, supplies, raw materials, and inventory.

Vehicles and Outside Property Damage = Damage to vehicles parked on premises; damage to inventory, materials, and equipment kept outside; and damage to signs, landscaping, and parking areas.

Preventive Costs = Costs of moving contents prior to and after flooding to avoid damage, costs of flood fighting.

Clean Up Costs = Costs of labor and materials to clean up interior and outside of building.

Business Record Replacement Costs = The financial costs and unpaid hours for reconstructing business records that were damaged by the flood.





TYPE OF DAMAGE





AMOUNT OF COST OR DAMAGE





STRUCTURE DAMAGE

$_________________________________





CONTENT DAMAGE

$_________________________________





VEHICLE DAMAGE

$_________________________________





PREVENTIVE COSTS

$_________________________________


CLEANUP COST

$_________________________________





LANDSCAPING AND OUTSIDE PROPERTY

$_________________________________



UNPAID HOURS OF TIME FOR CLEAN AND REPAIR









____________________ UNPAID HOURS



BUSINESS RECORD REPLACEMENT COSTS

$_________________________________



27. How long did the water remain in this building?

_____________ DAYS _____________ HOURS

Damage Susceptibility

28. At what elevation, relative to the 1st floor of the building, does flood damage to contents begin? (+ or – ; will only be negative if there is a subterranean level) ____________ feet



29. Please estimate damage to contents corresponding with water depths above/below the building’s 1st floor elevation. (Express damage in either $ or % of total value.)

Flood

Depth

Equipment

Furniture

Inventory/products

Low

Most Likely

High

Low

Most Likely

High

Low

Most Likely

High

-6.0 ft










-3.0 ft










-1.0 ft










0.0 ft










0.5 ft










1.0 ft










3.0 ft










6.0 ft












Notes to interviewer:

  • Shaded areas are for buildings with a subterranean level only. Please fill in appropriate values for the depth (e.g., -1.0 ft, -3.0 ft, -6.0 ft). Leave shaded areas blank if no subterranean level exists.

  • The values in the columns should be a cumulative total, starting from the lowest level of the structure.

  • Other Information


30. Is there a seasonal variation in the value of inventory in this building? Yes No

If yes, what is the average total value of your inventory during the following time periods:

January – March $ April – June $

July – September $ October – December $


31. Other than the principal structures, are there any other valuable items on your property that flood waters could damage, such as not readily movable (landscaping, electrical equipment, pipes, trailers on blocks, etc.)?

Type

Current Value ($)

Height Above Ground (ft.)


















- Movable (cars, trucks, trailers, etc.)



Type

Current Value

($)






























Flood Warning and Response

32. Just before (date) floods, how did you first become aware that flooding might reach your business? (CIRCLE ONE ANSWER)

  1. E-MAIL

  2. TEXT MESSAGE

  3. SOCIAL NETWORKING WEBSITE (FACEBOOK, TWITTER, SNAPCHAT, etc.)

  4. TV

  5. RADIO

  6. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

  7. TELEPHONE BY OTHER

  8. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

  9. FACE TO FACE BY OTHER

  10. LOUDSPEAKER

  11. SIREN

  12. C.B., HAM RADIO or POLICE SCANNER

  13. NEWSPAPER

  14. OBSERVING THE CREEK OR RIVER WATER LEVELS

  15. OTHER ______________________________________


32a. How many hours were there between the time you became aware that flooding might reach your business until the water actually reached your business property?

______ HOURS

33. What actions, if any, did you take to safeguard your business property

immediately prior to flooding and what were the dollar damages prevented by each action?


(PLEASE CIRCLE YES OR NO FOR EACH ACTION LISTED AND INDICATE THE DOLLARS DAMAGE PREVENTED FOR EACH ACTION.)

Damage Preventive Action

Took Preventive Action

(CIRCLE)

Dollar Damage Prevented

$____ or Circle DK for Don’t Know

1. Moved contents to higher ground

Yes No

$_________ DK

2. Elevated contents to a higher spot in the building

Yes No

$_________ DK

3. Shut off electrical equipment

Yes No

$_________ DK

4. Sandbagged the outside of the building

Yes No

$_________ DK

5. Used another type of temporary barrier

Yes No

$_________ DK

6. Moved vehicles to higher ground

Yes No

$_________ DK

7. Other action: _____________________________

Yes No

$_________ DK

8. None

Yes No

$_________ DK



34. Emergency Measures/Plans:

34a. What emergency measures/plans, if any, would you take to reduce damage if you were forewarned of eminent flooding?

34b. What is your estimated cost to implement these emergency measures?

$

34c. How much time in man hours is required to implement these emergency measures?

MAN HOURS

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