Rapid Evaluation Safety Assessment Form
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1Rapid Evaluation Safety Assessment Form
Inspection
Inspector ID:
Inspection Date and Time
Affiliation:
Areas Inspected:
Exterior
Interior
Building Description
Type of Construction
Building name:
Wood Frame
Concrete Shear Wall
Address:
Steel Frame
Unreinforced Masonry
Tilt-up Concrete
Reinforced Masonry
Contact Phone:
Conc. Frame
Other_____________
No. Stories above ground:_____
below:____
Primary Occupancy
Approx. “footprint area” (s.f.):___________
_
Dwelling
Commercial
Government
No. Residential units:
Other Res.
Office
Historic
No. Res. units not habitable
Assembly
Industrial
School
Emerg. Services
Other_________
Evaluation
Est. Building Damage
Investigate the building for the conditions below and check the appropriate column
(excluding contents)
Observed Conditions:
Minor/none
Moderate
Severe
None
Collapse, Partial collapse, off foundation
0-1%
Building or story leaning
1-10%
Racking to walls, other structural damage
11-30%
Chimney, parapet, other falling hazard
31-60%
Ground slope movement or cracking
61-99%
Other (specify)
100%
Comments:
Posting
Choose a posting based on the evaluation and team judgment. Severe conditions endangering the overall building are
grounds for an Unsafe posting. Localized severe and overall moderate conditions may allow a Restricted posting. Post
INSPECTED placard at main entrance. Post RESTRICTED USE and UNSAFE placards at all entrances
Inspected (Green placard)
Restricted Use (Yellow placard)
Unsafe (Red placard)
Record any use/entry restrictions exactly as written on placard:
Further Actions
Check the boxes below only if further actions are needed.
Barricades needed in the following areas
Detailed Evaluation Recommended:
Structural
Geotechnical
Other:
Other recommendations:
Comments:
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Parent category: Business