Damage Assessment Forms

Damage Assessment Manual by www.GreenAlert.
net
Update 6/2/2004 8:51 AM
SPECIAL NOTE: All Forms in Appendix A can be downloaded from our Web Site at: www.greenalert.net
Appendix A - 1 Forms
Damage Assessment Manual by www.GreenAlert.net
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Table of ContentsAppendix A Forms

Business & Residential Value Worksheet.................................................................................................A-5 Windshield Survey Form DA-1 .................................................................................................................A-6 Damage Levels and Conditions for Windshield Survey............................................................................A-7 Program Referenced Damage Levels ......................................................................................................A-8 Structure Habitability and Percent of Value Charts...................................................................................A-9 Windshield Survey-Individual Assistance (IA) Form IAF-1 .......................................................................A-9 Individual Assistance Reporting Worksheet ...........................................................................................A-10 Site Housing Losses ..............................................................................................................................A-11 Instructions for Site Housing Losses......................................................................................................A-12 Site Estimate Business Losses...............................................................................................................A-13 Instructions Site Estimate Business Losses ...........................................................................................A-14 Project Worksheet...................................................................................................................................A-15 Instructions for the Project Worksheet ...................................................................................................A-16 Public Assistance Damage Assessment Summary Sheet .....................................................................A-17 State of Texas Public Assistance Forms (Example)...............................................................................A-18 Damage Assessment General Items Checklist 1 ...................................................................... A-19 to A-20 Damage Assessment Private Residences Checklist 2...........................................................................A-21 Damage Assessment Checklist 3 ...........................................................................................................A-22 Agriculture Natural Disaster Damage Assessment Report Form DA-BIZ-AD-1.....................................A-23 Damage Assessment Situation Report Form INT-92-108......................................................... A-24 to A-31 Right of Entry Agreement (Sample Form) ..............................................................................................A-32 Authorization for Removal of Buildings...................................................................................................A-33 Damage Assessment Team Databases.................................................................................... A-34 to A-37 Force Account Labor Summary Record .................................................................................... A-38 to A-39 Force Account Equipment Summary Record ............................................................................ A-40 to A-41 Force Account Equipment Summary Record .........................................................................................A-42 Contract Work Summary Record............................................................................................................A-43 Applicants Benefits Calculation Sheet ...................................................................................... A-44 to A-45 FEMA Schedule of Equipment Rates ........................................................................................ A-46 to A-52 Cost Summary Sheet..............................................................................................................................A-53
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Business & Residential Structural Value Worksheet

When an emergency or disaster occurs, a need exists to determine the damages that were caused by the disaster. This information is required to determine the severity of the disaster, but more important to determine what kinds of disaster assistance may be required. Some of the most frequent types of damages are those to residential structures, including, business structures, single family residences, duplexes or townhomes, apartment complexes, mobile homes, and vacation or resort cabins. The value of residential structures varies considerably because of a number of factors, including size, age, condition, and location. Because of these factors, particularly the location, this worksheet cannot pre-determine residential structure values and should only be used as an estimate. Those having the most knowledge about such values include, local building assessors, local appraisers, local real estate agents, and insurance adjusters. The Business & Residential Structure Value Worksheet below should be filled in with the aid of such knowledgeable persons.
Business & Residential Structural Value Worksheet

Location or Grid #
Typical Structure Value

Average Value
Type of Structure Businesses (each unit) Small homes or cottages two bedrooms or less and 1,000 square feet or less Average home two to four bedrooms and 1,000 to 2,000 square feet Large home four or more bedrooms and over 2,000 square feet Apartments (each unit) Single wide mobile homes Double wide mobile homes Duplexes or townhomes (each unit priced the same as similar sized homes) Condominiums (each unit priced the same as similar apartments)
$ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________
Windshield Survey Form DA-1

North Street ______________________________ South Street: ____________________________________ East Street: ______________________________ West Street: ____________________________________
GRID _________
County: _____________ City: _______________ Sub-division: ________________ Disaster Description __________________________
Survey Area Boundaries:
Surveyed By: _________________________ Title: ______________________ Phone: ________________ Date: ____________________
Type
Destroyed
Destroyed Total Major Minor Affected
Major Total
Minor Total
Not % Habitable Insurance
Total
Single Family Structure
Multiple Family Structure
Mobile Homes
Other
Businesses
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TOTALS
Windshield Survey Form DA-1
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Damage Levels and Conditions for Windshield Survey

Damage Level

Conditions Present in Residential & Business Assessment

Water above the first-floor doorknob Two or more basement walls collapsed Structure leveled above foundation Second floor is gone Two exterior walls collapsed Moved off foundation Water on first floor 6 inches to doorknob Water on main floor more than 24 hours Foundation damaged (bowed or collapsed wall) One exterior wall collapsed, exterior frame damage (bowed walls-non cosmetic), roof off or collapsed, 6 inches or less of water in a mobile home Exits blocked in addition to other damage One room destroyed (pertains to apartment renters) Accessory/service/outbuildings damaged (business) Production equipment/office equipment (business) Utilities damaged to include well, septic system, electrical service, and gas Carpets soaked on first floor Damage to the homes mechanicals such as furnace, water heater, baseboard heat, and air conditioner in need of repair or replacement Sewer backup or flood water in unfinished basement Insulation damage in crawl space or mobile home belly board Interior floor, walls; minor structural damage to exterior walls Trees fallen on structure, minor damage to exterior walls and interior floor Shingles/roofing removed or damaged exposing the sheathing Business inventory destroyed (business), fire escape not usable (pertains to businesses and multi-family units), fleet/vehicle damage (business) Less than 6 inches of water in unfinished basement Cosmetic damages to shutters, gutters, shingles, and siding Porch damage/deck damage Downed trees in yard that do not impede access to home Fireplace/wood burner chimney damage Broken windows, parking lot damage (business), business signs damaged (business), damage to landscaping (business) Damage to public or private roads/culverts that impede normal access to primary residence House surrounded by water and only accessible by boat Only access is by driving through farm field In estimating insurance coverage, renters are less likely to have insurance. Low income residents are less likely to have insurance. Homeowners who are still paying off their mortgage normally have the appropriate type of insurance. Residents who are flooded and reside in an area that does not participate in the NFIP or in an area that has been sanctioned for NFIP code enforcement violations will not have flood insurance. Residents who are flooded but whose property is not located in the Special Flood Hazard Area (SFHA) will probably not have flood insurance.
Destroyed 80%
Major 30%
Minor 5%
Affected but Habitable
Inaccessible

Insurance
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Program-Referenced Damage Levels

Local/State
FEMA
SBA
Red Cross
Destroyed
Destroyed
Destroyed
Major
Major Major
Major
Minor Affected but Habitable Inaccessible
Minor
Inaccessible
The above chart titled "Program-Referenced Damage Levels" provides a general indication of the damage designation that various assistance programs and agencies assign to damage conditions.
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Structure Habitability
This system may be used in addition to the percent of value system. This system divides the residences into categories not based on dollar damages but upon the habitability of the structure; can it be lived in? Common habitability categories are: The residence can be occupied after repairs are accomplished. These repairs should be those that can be accomplished within a comparatively short time; one to two weeks. The residence cannot be occupied within a comparatively short time, if ever, because the necessary repairs are too time consuming or not practical. The residence cannot be occupied within a comparatively short time, if ever, because the necessary repairs are too time consuming or not practical.
Damage by Percent of Value

In this system the damage assessor divides damaged residences into damage categories; each category representing a range of percent of damage based on the value of the structure (preceding section). Percent damage categories to be used are: The structure may still be used for its intended purpose or may be restored to service with minimal repairs. The damage constitutes less than 10 percent of the value of the structure and averages about 5 percent. The structure cannot be used or may be used under limited conditions or reduced levels of service or may be restored to use with extensive repairs. The damage is over 10 percent but less than 80 percent of the structure's value and averages at 30 percent. The structure no longer exists or is damaged to the extent that it is no longer usable and that restoration to use is not technically or economically feasible. The structure is damaged to over 80% of its value and usually will not be repaired. Assume 80 percent damage for these situations.
Habitable
Minor Damage
Habitable With Minimum Repair
Major Damage
Not Habitable or Destroyed
Destroyed
Figure 3.8 Structure Habitability and Percent of Value Charts
Windshield SurveyIndividual Assistance Team GRID AREA -_____ Number of Structures & Estimated Damage Costs Form IAF-1 Individual Assistance Assessment
Low-Cost Homes (9) Medium-Cost Homes (10) High-Cost Homes (11) Mobile Homes (12) Businesses (13) Multiple-Dwelling Homes (14) Other - (15) Other - (15) Other - (15) TOTAL DAMAGES (16) Average Property Value (1) Number Destroyed 80% (2) Destroyed Repair Cost (3) Number Major Damage 30% (4) Major Repair Cost (5) Number Minor Damage 5% (6) Minor Repair Cost (7) Total Damage Costs (8)
Figure 3.10 - Windshield SurveyIndividual Assistance Form IAF-1
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Individual Assistance Reporting Worksheet

City/County State Person Filing Report (Name Title)
PEOPLE AFFECTED
Deaths Injuries Missing
ASSISTANCE PROVIDED
Persons Evacuated Persons in Public Shelters
RESIDENTIAL HOUSING Number Houses destroyed (ARC)

3
Primary Value (if Known) $ $

1
Secondary Number Value (if Known)
$ $
$ $ $ $ $ $ $ $
Houses with major damage (ARC)2 Houses with Minor Damage (ARC) Houses Affected Mobile Homes Destroyed (ARC)
3 2
$ $ $ $ $ $
Mobile Homes Severely Damaged (ARC)
Mobile Homes Moderately Damaged (ARC)1 Mobile Homes Affected
TOTAL
Total Residential (primary plus secondary) BUSINESS

Businesses Affected Number Now Unemployed Estimated Duration of Unemployment (weeks)
TOTAL BUSINESS $
AGRICULTURE (from Form DA-BIZ-AG-1

Farm Buildings and Equipment $ Crop Land (all crops) $ Livestock $
TOTAL AGRICULTURE $ INDIVIDUAL DAMAGE TOTAL $
Site Estimate - Housing Losses
(1) County: __________________ (2) City: ________________________ (3) State _______ (4) Damage Assessment Team ___________
(5) Incident Period: ____________________________ (6) Date of Survey ___________________________ (7) Page _____ of ______.
(10) (11 (12) (13) (14) (15) (16) (17) (18) (19) (20) (21)
(8)
(9)
Name Ref Address # Phone
Type of Damage Structure Category SF Destroyed MP Major MH Minor Structure Residence Status Occupied Primary Own Yes or Rent Secondary No Fair Replacement Value Estimated Loss $ Anticipated Insurance $ _________ Structure _________ Contents _________ Structure _________ Contents _________ Structure _________ Contents _________ Structure _________ Contents _________ Structure _________ Contents _________ Structure _________ Contents SF ____ MF ____ MH ____ DEST___ MAJ_____ MIN_____ H____ M_____ L_____ Y _____ N _____ Y ___ N ___ P _____ S _____ _________ Structure _________ Contents
Estimated Water Income Level in Structure High (In Feet) Medium Low
Amount of Insured Loss
Percent of Insured Loss
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TOTALS
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Instructions for Site Assessment Housing Losses

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) County where the damage is located City if in the corporate limits Note the type of incident Identity the team members Date(s) of the incident Date(s) of the survey Page number Locally established reference number - 1,2,3. ..etc. Name of occupant, street address, phone Type of Structure ( SF - Single Family, MH - Mobile Home, MF - Multi-Family) Damage Category - Destroyed, Major, Minor Water Level in Structure (in feet) Estimated income (High, Medium, Low) Is structure occupied? Own/rent Primary/Secondary Residence secondary structure is occupied; evaluate extent of damage and % of uninsured loss to the tenant's property and evaluate extent of damage and % of uninsured loss to the owner's property) Fair Replacement Value (structure and contents) Estimated dollar loss Anticipated insurance Amount of uninsured loss (subtract the anticipated insurance from the estimated loss) Percent of uninsured loss (divide the amount of uninsured loss by the fair replacement value)
(17) (18) (19) (20) (21)
Site Estimate Business Losses
(1) County: __________________ (2) City: ________________________ (4) Damage Assessment Team ________________________
(5) Incident Period: ____________________________ (6) Date of Survey ___________________________ (7) Page _____ of ______.
REF NO. (8) Employees Fair Replacement Value (13) (14) (15) (16) No. (11) UI (12)
Name of Business Name of Tenant/Owner Type of Business Street Address Phone No. (9)
Estimated Days out of Operation (10)
Estimated Dollar Loss
Amount of Anticipated Insurance
% Uninsured Loss
IF Column 16 is: < 40% MIN (17)
> 40% MAJ (18)
Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________ Contents $______________ Structure $_____________ Land: $________________
$____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $____________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________
$___________
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Instructions for Site Assessment Business Losses

(1) (2) (3) (4) (5) (6) (7) (8) (9) County where the business is located City, if in the corporate limits Note the type of incident Identify the team members Date(s) of the incident Date(s) of the survey Page number Reference number (for local use) Name of business, tenant/owner, street address and phone number and type of business; note that if the business is renting building space, the building owner will need to be contacted to determine the extent of structure damage and percent of uninsured loss. Estimated days business will be out of operation Total number of employees Number of employees in which unemployment insurance is carried Fair replacement value, for this purpose, is the cost to replace equivalent real/ personal property, or the fair market value of the pre-disaster property, whichever is less for each potential applicant. Estimated dollar loss The amount of anticipated insurance. Anticipated insurance is normally calculated by subtracting any deductible, depreciation or unrecoverable loss from the estimated repair cost. Percentage of uninsured loss. Uninsured loss for this purpose, is the dollar amount of damage less any insurance received to repair that damage. Dollar value of uninsured loss = Percent of uninsured loss fair replacement value (17) (18) If column 16 is less than 40 percent, it is considered minor damage If column 16 is greater than 40 percent, it is considered major damage
(10) (11) (12) (13)
(14) (15)
(16)
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Project Worksheet
Special Location Information
Declaration # Project # FIPS # Date Category
Damaged Facility Date Applicant
Work Complete as of: Percent County
Location
Latitude
Longitude
Damage Description and Dimensions
Scope of Work
Does the Scope of Work change the pre-disaster conditions at the site? Special Considerations issues included? Hazard Mitigation proposal included? Is there insurance coverage on this facility? Project Cost Item Code Narrative Quantity/ Unit
Yes or No Yes or No Yes or No Yes or No
Unit Price
Cost
Total Cost Prepared by:
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PROJECT WORKSHEET INSTRUCTIONS (FEMA Based) The Project Worksheet must be completed for each identified damaged project. Projects with estimated or actual cost of damage greater than $47,100 are large projects. Projects with estimated or actual cost of damage less than $47,100 are small projects. Declaration No: Indicate the disaster declaration number as established by FEMA (i.e. "FEMA 1136-DR-TN", etc.). Project No: Indicate the project designation number you established to track the project in your system (i.e. 1, 2, 3, etc.). FIPS No: Indicate your FIRS number within this space. This is optional. Date: Indicate the date the worksheet was prepared in MM/DD/YY format. Category: Indicate the category of the project according to FEMA specified work categories. This is optional. Applicant: Name of the governmental or other legal entity to which the funds will be awarded. County: Name of the county where the damage is located. If located in multiple counties, indicate '~MultiCounty." Damage facility: Identify the facility and describe its basic function. Work Complete as of: Indicate the date that the work was examined in the format of MM/DD/YY and the percentage of work completed to that date. Location: This item can range anywhere from an "address," "intersection of..."" 1 mile south of ...on to "county wide." If damages are in different locations or different counties please list each location. Include latitude and longitude of the project if known. Damage Description and Dimensions: Describe the disaster-related damage to the facility, including the cause of the damage and the area or components affected. Scope of Work: List work that has been completed, and work to be completed, which is necessary to repair disaster-related damage. Include items recorded on the preliminary damage assessment. Does the Scope of Work change the pre-disaster conditions of the site: If the work described under the Scope of Work changes the facilities conditions (i.e. increases I decreases the size or function of the facility or does not replace damaged components in kind with like materials), check Yes. If the Scope of Work returns the site to its pre-disaster configuration, capacity and dimensions check no. Special Considerations: If the project includes insurable work, and/or is affected by environmental (NEPA) or historic concerns, check either the Yes or No box so that appropriate action can be initiated to avoid delays in funding. Refer to Applicant Guidelines for further information. Hazard Mitigation: If the pro-disaster conditions at the Figure 3.17 Project Worksheet Instructions site can be changed to prevent the disaster-related damage, check Yes. If no opportunities for hazard mitigation exist check No. Appropriate action will be initiated and avoid delays in funding. Refer to the FEMA Applicant Handbook for further information. Is there insurance coverage on this facility: Federal law requires that FEMA be notified of any entitlement for proceeds to repair disaster-related damages, from insurance or any other source. Check Yes if any funding or proceeds can be received for the work within the Scope of Work from any source besides FEMA.
Project Cost
Item: Indicate the item number on the column (i.e. 1, 2, 3, etc.). Use additional forms as necessary to include all items. Code: If using the FEMA cost codes, place the appropriate number here. Narrative: Indicate the work, material or service that best describes the work (i.e. 'force account labor overtime", "42 in. Dia. RCP". "sheet rock replacement", etc.). Quantity Unit: List the amount of units and the unit of measure ("48/cy", "32/If, "6/ea", etc.). Unit Price: Indicate the price per unit. Cost: This item can be developed from cost to date, contracts, bids, applicant's experience in that particular repair work, books that lend themselves to work estimates, such as RS Means, or by using cost codes supplied by FEMA. Total Cost: Record total cost of the project. Prepared By: Record the name and title of the person completing the Project Worksheet.
Record Requirements
Please review the Applicant Handbook for detailed instructions and examples. For all completed work, the applicant must keep the following records:
Force account labor documentation sheets identifying the employee, hours worked, date and location; Force account equipment documentation sheets identifying specific equipment, operator, usage by hour/mile and cost used; Material documentation sheets identifying the type of material, quantity used and cost; Copies of all contracts for work and any lease/rental equipment costs.
For all estimated work, keep calculations, quantity estimates, pricing information, etc. as part of the records to
Form DA-BIZ-PW-1
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Public Assistance Damage Assessment Summary Worksheet

Original Type of Disaster: Revision Date:
Date (s) of Occurrence
Jurisdiction (town, county, agency, etc.):
County:
Information Provided By: Name: Address: Title: Day Phone: Evening Phone:
CATEGORY
PUBLIC INFRASTRUCTURE DAMAGE

Debris Removal: - Trees, building wreckage, sand, mud, silt, gravel, vehicles, and other disaster-related material. Emergency Protective Measures: - Sandbagging, barricades, signs, extra police and fire, and emergency health measures. Roads and Bridges: - Roads, culverts, bridges, and associated facilities.
A B C D E F G
Water Control Facilities: - Dams, reservoirs, shore protective devices, pumping and irrigation facilities, drainage channels, and levees. Buildings and Equipment: Buildings, supplies, inventory, vehicles, and equipment. Utilities: - Water treatment plants and delivery systems, power generation and distribution facilities, sewerage collection systems and treatment plants. Parks, Recreational, and Others: - Playground equipment, swimming pools, bath houses, tennis courts, boat docks, piers, picnic tables, cemeteries, and golf courses.
TOTAL $
Private Nonprofit: - Educational, medical, custodial care, emergency (Fire departments, search and rescue, and ambulances), utility, and other (museums, community centers, libraries, homeless shelters, senior citizen centers, health and safety services).
PUBLIC DAMAGEGRAND TOTAL $

KEY FOR DAMAGE CATEGORY
(Use appropriate letters in the category blocks below) A. Debris Clearance B. Protective Measures C. Road Systems Site # D. Water Control Facilities E. Buildings and Equipment F. Public Utility System G. Other
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LOCATION (Use map location, address, etc.)
Category
Description of Damage
Impact
Insurance
% Complete
Cost Estimate
Example of Form used in the State of Texas to Report Public Assistance Damages
PUBLIC ASSISTANCE DAMAGE ASSESSMENT CHECKLIST (To Prepare for State and/or Federal Inspectors)
In order to expedite the damage assessment process, applicants should take the following steps before the arrival of the State and Federal assessment team: 1. Mark the location of each damage site on a suitable map and develop a route of travel to each site. Segregate damage/work activities into the seven categories of work, listed on the front of this worksheet. All damage sites should be identified by the applicant before the inspectors arrive. Ensure that the person designated to accompany the survey team is knowledgeable of the repairs already made and the location of all other damage sites which need to be repaired/surveyed. Have photographs, site sketches or drawings of each damage site available for the inspectors (especially where work has already been performed). Compile a detailed breakdown of labor (including fringe benefits), equipment, and material costs for each location where work has been completed or is in progress. While a variety of forms can be used to summarize these items, the format chosen must document the type and location of work performed on a daily basis. Record force account equipment use in a manner compatible with the FEMA Schedule of Equipment Rates. Keep damaged equipment and parts for review and inspection by the survey team. List equipment, materials or inventory lost as a result of the disaster. Provide copies of estimates, bids, purchase orders, invoices, inventory records or other substantiating evidence to verify loss values or replacement cost. Be prepared to describe to the inspectors which sites will be repaired by contract and those which will be repaired by force account. If a contractor's estimate/bid has been received, have it available for the inspectors. Provide inspectors with policy information on insurance coverage and any proceeds received or anticipated.
2. 3. 4.
5. 6.
7.
8.
Figure 3.22Example Source: GOVERNORS DIVISION OF EMERGENCY M ANAGEMENT, TEXAS DEPARTMENT OF PUBLIC SAFETY PUBLIC PROPERTY SITE ASSESSMENT WORKSHEET DEM 25
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Damage Assessment General Items Checklist 1

In conducting the damage assessment, you will be gathering information needed to point out an accurate mental picture of the damage, and of its impact on the people and their communities. The subjects listed below represent important aspects of assessments, which may be applicable to the situation you are assessing. In each of your basic areas of damage assessment, it is assumed that you will obtain basic information on numbers and dollars (the number of people unemployed by the disaster, and number of homes destroyed, the number of businesses damaged, etc.). In addition to these basic measures, however, you should consider the following subjects, determine whether they are applicable to your situation, and if they are, include them in your description of the impact of the damage on the area.
1.
Area ________________________________________________________ _____________________________________________________________ _____________________________________________________________

(whether it's primarily rural, suburban, or urban, or a combination of the three may be important)
2.
Debris _______________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(It may pose a health hazard, prevent access to homes, or block roads.
3.
Type of Incident _______________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(earthquake, flooding, tornado, hurricane, etc. describe) -(Consider such things as depth of water, length of time the area was flooded, whether the flood water was fast moving, whether it contained harmful chemicals).
4.
Transportation Need ___________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(An estimate of the need for transportation by either public or private means).
5.
Death/Injury Impact ____________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(The incidence of death and injury is important and should be reported especially where it results in special needs emergency medical care, pubic health assistance, etc.).
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Damage Assessment General Items Checklist 1 6. Personal Property Loss_________________________________________ _____________________________________________________________ _____________________________________________________________
(An estimate of the extent of personal property loss).
7.
Economic Description _________________________________________ _____________________________________________________________ _____________________________________________________________ Availability of Local Resources __________________________________ _____________________________________________________________ Emergency Food/Shelter________________________________________ _____________________________________________________________
(If there is a significant number of displaced people, identify where they are and if mass feeding is required).
8. 9.
10.
Nature of the Threat ___________________________________________ _____________________________________________________________ _____________________________________________________________

(Note the condition which threatens public health, safety, and/or property, and describe the threat).
11.
Nature of Protective Work ______________________________________ _____________________________________________________________ _____________________________________________________________

(Include such measures as pumping, sandbagging, vector control, stream clearance, etc. Describe what needs to be done).
12.
Impact _______________________________________________________ _____________________________________________________________ _____________________________________________________________

(Determine what essential services, if any, are affected by the threatening situation).
13.
Local Response _______________________________________________ _____________________________________________________________ _____________________________________________________________
(Describe what the local and state governments and or private volunteer groups are doing to deal with the problem, and the need, if any, for additional resources to combat it).
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Damage Assessment Private Residences Checklist 2 1. Transient Accommodations ____________________________________ ____________________________________________________________ ___________________________________________________________
(Their availability, in terms of hotel/motel rooms, etc.)
2.
Rental Housing _______________________________________________ ____________________________________________________________ ____________________________________________________________

(Its availability in such categories as single family, attached, multi-family, etc)
3.
Mobile Homes ________________________________________________ ____________________________________________________________ ____________________________________________________________

(Their acceptability and extent of their use in the area. Also, the extent of pad vacancy in local mobile home parks)
4.
Utilities _____________________________________________________ ____________________________________________________________ ____________________________________________________________ (

Their operational status. If out of commission, for how long? Are service outages widespread or concentrated?)
5.
Construction Types ___________________________________________ ____________________________________________________________ ____________________________________________________________

(Prevalent types used in the area (brick, wood frame, concrete block, basement, or on a slab, etc.)
6.
Dwelling Types _______________________________________________ ____________________________________________________________ ____________________________________________________________

(A general description of the types of housing damaged by the disaster (single family homes, apartments, mobile homes, etc.)
7.
Dwelling Values _______________________________________________ _____________________________________________________________

(Damaged homes may be low, medium or high cost homes for the area.)
8.
Insurance Coverage ____________________________________________ _____________________________________________________________ (A general estimate of the percentage of damaged homes and personal property covered by insurance. Identify your source of information)
Note: This form should accompany the Damage Assessment Residences Form INT-92-102
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Damage Assessment Private Business Checklist 3 1. Types of Businesses __________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
(A description of the types of businesses and business inventories affected and the impact on the community)
2.
Recovery Time ________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(An estimate of how long it will be before businesses will be restored and back in operation again)
3.
Construction Types ____________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(Prevalent types used in the area (brick, wood frame, concrete block, basement, or on a slab, etc)
4.
Available Business Rentals _____________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(Their availability and location)
5.
Insurance Coverage ___________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(A general estimate of the percentage of damaged businesses covered by insurance. Identify your source of information)
Note: This form should accompany the Damage Assessment Businesses Form INT-103
Agriculture Natural Disaster Damage Assessment Report Form DA-BIZ-AG-1

State (1) County (2) Brief Description of Disaster (5) Yes/No Number Yes/No Concurrence with Reported Data (6) CEB SEB Number
Number of Farmers in County In Business as an Owner-Operator or Tenant Operator (3)
Disaster Date (4)
Number of Farmers with Production Losses (14) Acres Normally Grown in County in Disaster Year (8) Disaster Year Yield Per Acre for Acres Grown in Disaster Year (10) Acres not Planted in the Disaster Year (11) 100% Losses 90 to 100% Losses 80 to 89% Losses 70 to 79% Losses 60 to 69% Losses 50 to 59% Losses 40 to 49% Losses 30 to 39% Losses 20 to 29% Losses 10 to 19% Losses Less than 20% Losses # with Physical Losses Major Minor Loss Dollars (16) Homes Mobile Homes Service Buildings Machinery and Equipment Other Farm Buildings and Equipment # Destroyed (17) # Major Damage # Minor Damage
Number (14a)
Crops (7)
Acres Normally Grown in County (8)
Livestock & Poultry
Number and Kind Destroyed (15)
Loss (Dollars) (18)
Cattle
Sheep
Hogs
Poultry
Aquaculture
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Remarks (19)
Form DA-BIZ-AG-1
Damage Assessment Manual by www.GreenAlert.net Damage Assessment Situation Report Form INT-92-105, Page 1 of 2
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1. Reporting location ________________________________________________________ 2. Cause of Damage_________________________________________________________ 3. Area Affected ____________________________________________________________

NOTE: If this is a county report but does not include affected cities and towns in the county, specify the city or towns excluded. (Example Arapahoe County in Colorado has Englewood).
4. Persons Affected (insert numbers in spaces provided)

A. D. Killed Displaced B. E. Injured Missing C. F. Sick Hospitalized
5. Damage to Essential Facilities (indicate capacity lost and estimated dollar loss)
A. B. C. Hospital Power Plants Food Availability % % % $ $ $ D. E. F. Communications Railroads % % % $ $ $
6. Damage to Public Property (indicate capacity lost and estimated dollar loss)
A. B. C. D. Roads Bridges Schools Irrigation Districts % % % % $ $ $ $ E. F. G. H. Water Treatment Sewage Plants Distribution Lines Airports % % % % $ $ $ $
7. Damage to Private Property (indicate capacity lost and estimated dollar loss)
A. B. Dwelling Units % $ $ C. F. Farms & Ranches Livestock % % $ $
Commercial Facilities %
8. 9.
Are there large accumulations of debris?
Yes
No (if yes, explain in remarks). Yes No.
Is the reporting government intact enough to fulfill its governing functions?
10. Dollar amount of government resources spent to date for event

Emergency Services Roads and Bridges Law Enforcement Fire and Rescue Other Services Contractual Services Sub Total TOTAL RESOURCES Personnel $ $ $ $ $ $ $ Materials $ $ $ $ $ $ Equipment $ $ $ $ $ $
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Damage Assessment Situation Report Form INT-92-105, Page 2 of 2
11. Assistance required to cope with the disaster or emergency (check ( ) requirement
PUBLIC NEEDS Restore Power Communications Transportation Secure Area Debris Clearance WATER SUPPLY Drinking Sanitary Sewers, Etc. Fire Fighting Other FLOOD FIGHTING Dike Building Sandbagging Pumps Other (specify VICTIM NEEDS Search & Rescue Evacuation Food Shelter Clothing Medical Other (Specify) ADMINISTRATION Activate EOC Public Announcements Maps Available for: General Disaster Area Specific Damage Sites Location EOC, DAC Field Offices
12. Location of EOC _________________________________________________________________________________ Telephone Number at EOC ( ) _ _ _ - __ __ __ __ Other Communications Available ____________________________________________________________________ 13. Amount of local government funding available for this disaster and expected to be appropriated? ________________________________________________________________________________________ _______________________________ ________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
14.
Remarks: ______________________________________________________________________________________
15.
Name and title of person filling out this report _______________________________ Date and Time _________________ _________________________ .
________________________
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Windshield Survey for Socio-Economic Impact Assessment, Page 1 of 6 I. Death and Injuries
# Do You Require Outside Assistance For: (Check As Required)
Body Search Body Evacuation Mortuary Services Identification
Other (specify Other (specify Other (specify
Death & Injuries

A. B. Dead Injured Requiring Hospitalization
Hospitalization Specialized Treatment Supplies Personnel

Other (specify Other (specify Other (specify
Explain All Boxes Checked:
II. Emergency Protective Measures:

1. 2.
Are there any conditions threatening public health and safety or any which pose a threat of further damages to public or private property ( ) yes, ( ) no. Do you require outside assistance for: _______ _______ _______ _______ Equipment Manpower Technical Assistance Other
Explain all Items Checked _________________________________________________________________________ _______________________________ ________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
III. Human Needs::

1. Estimated number of persons who will require additional funds to cover necessary expenses or serious needs which are covered by insurance or by state, federal, or volunteer agency disaster relief programs. Do you require mass feeding ( ) yes, ( ) no. A. Total number of persons requiring mass feeding _____________________________________ .
2.
B. Total Number of persons presently being fed ________________________________________ . C. Number of persons still requiring feeding ___________________________________________ .
D. Outside assistance needed (food, preparation, storage, etc.): ___________________________ . 3. 1. Food StampsEstimated number of persons who may be eligible for food stamps ______________ . Is there a requirement for shelter and housing? ( )yes, ( )no. Estimated number of persons needing short term (up to 30 days) shelter _____________________ . A. Available local shelter capacity _____________ _____________________________________ .
IV. Shelter and Housing: 2.
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Windshield Survey for Socio-Economic Impact Assessment, Page 2 of 6

IV. Shelter and Housing:
1. 2. Is there a requirement for shelter and housing? ( )yes, ( )no. Estimated number of persons needing short term (up to 30 days) shelter _____________________ . A. Available local shelter capacity _____________ _____________________________________ . B. 3. Outside shelter spaces needed __________________________________________________ .
Number of families needing long-term (over 30 days) housing ______________________________ . A. Available housing units _________________________________________________________ . B. Outside housing assistance needed _______________________________________________ . C. Local mobile home pads available ________________________________________________ . D. Can space and utility services be prepared for additional mobile homes within 30 days? ( ) yes, ( ) no. How many? _________________________________________________ . Is there a health/sanitation problem? ( )yes, ( )no. Do you require outside help for: A. Immunization ___________________________ _____________________________________ . B. C. D. E. F. Potable Water _____________ __________________________________________________ . Sewage Disposal _____________________________________________________________ . Vector/Rodent Control _________________________________________________________ . Crisis Counseling _____________________________________________________________ . Hazardous Material Cleanup ____________________________________________________ . ) yes, ( ) no.
V. Health & Sanitation

1. 2.
V. Debris
1. 2. Is there a debris problem? ( Does debris threaten: A. Public Health _________________________________________________________________ . B. Safety ______________________________________________________________________ . C. Additional Property Damage _____________________________________________________ . Does debris prevent access by: Public Safety Forces 4. Homeowners Business Customers Recovery Teams
3.
Is outside assistance required for debris removal? ( ) yes, ( ) no. If yes, explain need for special equipment or manpower ____________________________________________________________ .
________________________________________________________________________________ .
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VII. Utilities:
1. Has there been damage to any private, public or private nonprofit utilities (including electric, gas, water, sewer, drainage, telephone, or broadcast media? ( )yes, ( )no.
Phase II Utility Information

Phase II Utilities Electric Gas Water Storage Water Distribution Water Supply Sewer Collection Sewer Treatment Telephone Transportation Irrigation Communications Number Of Persons Affected Duration Of Disruption Health & Safety Hazards Outside Assistance Required Manpower Equipment Supplies Technical Assistance
VIII.
1. 2.
Water Control Facilities:

Has there been damage to water control facilities? ( ) yes, ( Does the damage threaten:
Irrigation Work Dams
) no.
Dikes and Levees
Drainage Cannels
Debris Basins
3.
Can the facility withstand additional damage? ( ) yes, (

Power Flood Control Farmland
) no.
Transportation Other
Irrigation
Urban Areas
4. 5.
Will the damage require evacuation? ( ) yes, ( Do you require outside assistance for:
) no. If yes, estimated number of people _________ .
Equipment
Manpower
Material
Technical Assistance
Other
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IX. Buildings and Appurtenances:
1. Has there been damage to any public buildings and their importance to the community ? ( )yes, ( ) no.
IX. Buildings & Appurtenances

Type Damage To ( ) yes Critical to Public Health & Safety Duration Of Disruption Outside Assistance Required Manpower Material Equipment Technical Assistance Facility
Public Buildings Hospitals Schools Commercial Structures Transport Facilities Prisons Other
________________________________________________________________________________ .
IX. Buildings and Appurtenances:

1. Has there been damage to roads and bridges? ( )yes, ( )no.
X. Roads and Bridges

Type Damage To ( ) yes Critical to Public Health & Safety Duration Of Disruption Outside Assistance Required Manpower Material Equipment Technical Assistance Facility
School Bus Route Mail Routes Fire Protection Hospital Access Residential Access Commerce Public Safety/Security Major Employer Others
___________________________________________________________________________
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XI. Business:
1. Has business damage resulted in the loss of essential goods or services? ( )yes, ( )no. If yes, which services ______________________________________________________________ . ________________________________________________________________________________ . ________________________________________________________________________________ . A. Is outside assistance required to supply these essential services? ( )yes, ( )no. B. Number of persons unemployed because of the disaster (include all self-employed persons: ___ . Approximate percent of local work force this number represents: _________________________ . C. Estimated loss of private income: __________________________________________________ . (Percent of total tax base) ________________________________________________________ . D. Estimated recovery time for business sector: _________________________________________ .
XII.
1. 2. 3. 4. 5. 6. 1. 2. 3. 4. 5. 6. 7.
Agriculture:
Have farming/ranching or related operations been affected? ( )yes, ( )no. What percent of your local economy can be directly attributed to agriculture? ___________________ . Estimated loss of agricultural income? _________________________________________________ . Estimated recovery time for agricultural sector ___________________________________________ . Number of agricultural workers unemployed _____________________________________________ . Number of agricultural self-employed who are unemployed _________________________________ . Number of elderly affected: __________________________________________________________ . Number of infirm affected: ___________________________________________________________ . Number of non-English speaking persons affected: _______________________________________ . Number of low income or fixed income persons affected (I.e. those living on Social Security, persons, unemployment compensation). _______________________________________________________ . Number of permanent residents: ______________________________________________________ . Number of transient residents: ________________________________________________________ . Number of persons in affected custodial care facilities: _____________________________________ .
XII. Socio-Economic Profile of Victims:
XIV.
1.
Ability of Community to Respond:

HISTORY: Explain the effects of any of the following occurrences on the communitys respond to, or recover from, the disaster: A. B. ability to
Past Disasters: ________________________________________________________________ . _____________________________________________________________________________ . Economic slowdown, Business, or Agriculture: ________________________________________ . _____________________________________________________________________________ .
C. Population Change: ____________________________________________________________ . __________________________________________________________________________ . D. Population Characteristics (age, income, etc.) ________________________________________ . _____________________________________________________________________________ . _____________________________________________________________________________ . E. F. Legal Restrictions ______________________________________________________________ . _____________________________________________________________________________ . Shortage of Critical Resources: ____________________________________________________ .
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2. Financial status: Briefly describe the effects of the following on the communitys ability to respond to or recover from, the disaster: A. Tax Base (Estimate for this fiscal year): ____________________________________________ . B. Budget Surpluses or Deficits: _____________________________________________________ . _____________________________________________________________________________ . _____________________________________________________________________________ . C. Amount in Emergency Fund: $ ____________________________________________________ . D. Borrowing Capacity (Legislative Limited, Audit Rating, etc.) ______________________________ . __________________________________________________________________________ . _____________________________________________________________________________ . E. Ability to Levy Emergency Assessments: ____________________________________________ . Insurance: A. Public Facilities 1. Estimated total loss $ __________________________ . 2. Estimated percentage covered by insurance ________ . B. Business: 1. Estimated total loss $ __________________________ . 2. Estimated percentage covered by insurance ________ . C. Residential, non-agricultural: 1. Estimated total loss $ __________________________ . 2. Estimated percentage covered by insurance ________ . D. Other agricultural: 1. Estimated total loss $ __________________________ . 2. Estimated percentage covered by insurance ________ . E. Private nonprofit: 1. Estimated total loss $ __________________________ . 2. Estimated percentage covered by insurance ________ .
3.
SUMMARY
Explain in brief an evaluation of the communitys ability to respond to the present disaster and the overall impact on people and the social system as a result of the disaster: ___________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Damage Assessment Manual by www.GreenAlert.net SAMPLE
Update 6/2/2004 8:51 AM
RIGHT OF ENTRY AGREEMENT

I (We) __________________________________________ the owner(s) of the property commonly identified as _____________________________________. do hereby grant and give freely and without any coercion whatsoever, the right of access, entry, and use of and to said property to the City/Town of County of ____________________ State of __________ their agencies. contractors, and subcontractors thereof, for the purpose of inspecting, removing, and clearing any and all stormgenerated debris of whatever nature from the above described property as may be necessary in the accomplishment of the foregoing.
IT IS FULLY UNDERSTOOD THAT THIS PERMIT IS NOT AN OBLIGATION TO PERFORM DEBRIS CLEARANCE
The undersigned agrees and warrants to hold harmless_______________________(City/Town/ County) ___________________State of _____________ their agencies, contractors, and ___________ (County) subcontractors, for any damage of any type. whatsoever, either to the above described property or persons situated thereon and hereby release. discharge. and waive any and all action, either legal or equitable which might arise out of any use or activities on the above described property. The properly owner(s) reserves the right to mark all or any storm damaged sewer lines. water lines, and other utility lines to be used as future reference points. I/We (have have-not) (will _____will-not) receive any compensation for debris removal from any other source including SBA, ASCS, private insurance, or any other public assistance program. For the considerations and purposes set herein. I hereby set my hand and seal this ________ of __________ 19 __________________________________________ (Owner/Owners) __________________________________________ __________________________________________ (Current Address) __________________________________________ (Current Telephone No.) _________________________________ (Witness)
NOTE: This agreement must be completed prior to entry on private property for purposes
of conducting emergency or disaster work.
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SAMPLE
Authorization For Removal of Buildings

I (We), _____________________________________________ owner(s) of the property commonly identified as ______________________________________________________________________ (Street) (City/Town) (County) State of ______ hereby authorize that __________________________________________________ City/Town/District) (County) State of ________ , or its contractors or subcontractors to conduct the removal of structures or debris, located on the above described property except _______________________________________________ I (We) make this authorization because I(We) desire to volunteer this property without compensation recognizing that it presents a potential hazard to the public safety. Health, or welfare. The undersigned agree and warrant to hold harmless the ______________________________ and the State of _________ , including their agencies, contractors and subcontractors, for any damage of any type whatsoever either to the above described property or persons situated thereon and hereby release, discharge and waive any and all action, either legal or equitable which might arise out of any use or activities on the above described property. For the considerations and purposes set forth herein, I hereby set my hand and seal this _____day of 2000 __ . __________________________________________ _______________________________ (Witness) (Owner-Owners) _______________________________ (Owner-Owners) _______________________________ (Current Telephone Number)
NOTE: A Right of Entry Agreement must be negotiated at each site before work can start.
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State Emergency Management Office Team Leader

Last Name: Agency/Company Address 1 Address 2 Office Phone: Email: Home Phone: Team ID City: State: Zip: Cell Phone: Pager: Expertise: First Name:
Local Emergency Management Team Leader

Residential Damage Inspection Team



Last Name: Agency/Company Address 1 Office Phone: Email: Home Phone: Pager: City: State: Zip: Cell Phone: Expertise: First Name:
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Last Name: Agency/Company Address 1 Office Phone: Email: Home Phone: Pager:
First Name:
City: State: Zip: Cell Phone: Expertise:
First Name:
First Name:
First Name:

Business Damage Inspection Team
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First Name:
First Name:
First Name:
First Name:

Public Facilities Damage Inspection Team
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First Name:
First Name:
First Name:
First Name:
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Force Account Labor Summary Record Instructions

Force account is the term to refer to the applicants own personnel and equipment. Keep the following points in mind when compiling force account labor information: 1. 2. 3. Record regular and overtime hours separately. Record the benefits separately for regular and overtime hours. Most overtime hours include fewer benefits than regular hours. Attach an Applicant's Benefit Calculation Worksheet giving a breakdown of what is included in the benefits, by percentages (e.g., social security 20%, worker's compensation 3%, insurance 18%, etc.). Applicant can use an average rate if there are different benefit rates for different employees.
Complete the Record as Follows 1. Applicant: Enter organization's name.

2. 3. 4. 5. 6. 7. 8. PA ID: Enter the computer tracking number that FEMA assigns to the applicants organization. The PAC can provide it. PW#: Enter the project number assigned to this project. If the project number assigned by FEMA is known, use that number. Disaster Number: Enter the declaration number for this disaster here. The PAC can provide it. Location/site: Enter physical address or location of project. Category: Enter category of work, if known. Period Covering: Enter time period referenced for the information contained on this sheet. Description of Work Performed: Briefly describe the type of work that was performed.
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Force Account Labor Summary Record Instructions (continued)

1. Title: Enter the title or occupation of each employee who worked on the project. 2. REG: Enter the regular hours that each employee worked on the project. 3. OT: Enter overtime hours that each employee worked on the project. REMINDER: Only overtime is eligible for reimbursement for emergency work. Record both regular and overtime hours, so that personnel hours can be compared with equipment use hours, if necessary. 4. Total Hr: Total the hours for each employee and enter the result in this block. 5. Hourly Rate: Enter each employee's hourly rate. 6. Benefit Rate/Hr: Enter each employees hourly benefit rate. There should be different percentages for benefits pertaining to regular and overtime wages. 7. Total Hourly: Add the employee's hourly rate in the Rate/Hr block and the hourly benefits rate in the Benefits/Hr block and enter the result here. 8. Total Costs: Multiply the entries in Total Hours and Total Hourly and enter the result here. 9. Total Cost: Multiply the entries in the Total Hr and Total Rate/Hr blocks and enter the result here. 10. Total Cost for Force Account Labor Regular Time: Add the entries in the Total Cost, REG block for each employee and enter the results here.
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Force Account Equipment Summary Record Instructions

Force account is the term to refer to the applicants own personnel and equipment. Keep the following points in mind when compiling force account labor information. Complete the record as follows:
1. 2. 3. 4. 5. 6. 7. 8. 9. Applicant: Enter organization's name. PA ID: Enter the computer tracking number that FEMA assigns to the organization. The PAC can provide it. PW#: Enter the project number assigned to this project. If the project number assigned by FEMA is known, use that number. Disaster Number: Enter the declaration number for this disaster here. The PAC can provide it. Location/site: Enter physical address or location of project. Category: Enter category of work, if known. Period Covering: Enter time period referenced for the information contained on this sheet. Description of Work Performed: Briefly describe the type of work that was performed. Type of Equipment: Enter a brief description of the equipment, including the rated horsepower or capacity of the equipment. Be sure to include this information if applicant also uses a trade name or common name to describe the equipment, e.g., Ditch Witch.
10. FEMA Code: Enter the FEMA cost code for the equipment. 11. Operator's Name: Enter the equipment operator's name. 12. Date/Hours Used: Enter the dates and hours the equipment was used on the project. 13. Total Hours: Enter total hours equipment was in use. 14. Equipment Rate: Enter the hourly cost to use the equipment. 15. Total Cost: Multiply the number in the Total Hours block by the number in the Equipment Rate block and enter the result here. 16. Grand Totals: Add the numbers in the Total Hours blocks and Total Cost blocks enter the results here.
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Materials Record Summary Instructions

This form is used to record the costs of supplies and materials purchased in response to the disaster or used to repair damages caused by the disaster. Complete the record as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. Applicant: Enter organization's name. PA ID: Enter the computer tracking number that FEMA assigns to the organization. The PAC can provide it. PW#: Enter the project number assigned to this project. If the project number assigned by FEMA is known, use that number. Disaster Number: Enter the declaration number for this disaster here. The PAC can provide it. Location/Site: Enter physical address or location of project. Category: Enter category of work, if known. Period Covering: Enter time period referenced for the information contained on this sheet. Description of Work Performed: Briefly describe the type of work that was performed. Vendor: Enter the name of the supplier if the material was bought specifically as a result of the disaster.
10. Description: Enter a brief description of the supplies or materials used or purchased. 11. Quantity: Enter amount of material used. (e.g., number, tonnage, etc.). 12. Date Purchased: Enter the date on the invoice. 13. Date Used: Enter date actually used/installed. 14. Info From: Check whether information entered on the form was obtained from actual invoice or if material was taken from stock on hand. 15. Grand Total: Add the numbers in the Total Price blocks and enter the result here.
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Rented Equipment Summary Record Instructions

This form is used to record the costs of equipment that the applicant had to rent or lease to respond to the disaster or to be used in making repairs to damages caused by the disaster. Complete the record as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. Applicant: Enter organization's name. PA ID: Enter the computer tracking number that FEMA assigns to the organization. The PAC can provide it. PW #: Enter the project number assigned to this project. If the project number assigned by FEMA is known, use that number. Disaster Number: Enter the declaration number for this disaster here. The PAC can provide it. Location/Site: Enter physical address or location of project. Category: Enter category of work, if known. Period Covering: Enter time period referenced for the information contained on this sheet. Description of Work Performed: Briefly describe the type of work that was performed. Type of Equipment: Enter a brief description of the equipment that applicant leased or rented, including the rated horsepower or capacity of the equipment. Be sure to include this information if applicant also uses a trade name or common name to describe the equipment, e.g., Ditch Witch.
10. Dates/Hours Used: Enter the dates and hours the equipment was used on the project. 11. Rate Per Hour: Enter the hourly rental or lease cost of the equipment. Indicate if the equipment was rented on a daily, weekly, or monthly rate, instead of an hourly rate. List in appropriate column if operator costs were included. 12. 13. 14. 15. Total Cost: Multiply hours Used by Hourly Rate charged and enter total cost here. Vendor: Enter the name of the company that rented or leased the equipment to applicant. Invoice No.: Enter billing invoice number. Date/Amount Paid: Enter date of payment and amount of check.
16. Check No.: List check number that was used to pay for equipment rental. 17. Grand Total: Add the dollar figure from the Amount Paid blocks and enter total here.
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Contract Work Summary Record Instructions

This form is used to record the costs of contracts that applicant awarded to respond to the disaster or to make repairs to damages caused by the disaster. Complete the record as follows:
1. 2. 3. 4. 5. 6. 7. 8. 9. Applicant: Enter organization's name. PA ID: Enter the computer tracking number that FEMA assigns to the organization. The PAC can provide it. PW #: Enter the project number assigned to this project. If the project number assigned by FEMA is known, use that number. Disaster Number: Enter the declaration number for this disaster here. The PAC can provide it. Location/Site: Enter physical address or location of project. Category: Enter category of work, if known. Period Covering: Enter time period referenced for the information contained on this sheet. Description of Work Performed: Briefly describe the type of work that was performed. Invoice Number: Enter the invoice number.
10. Dates Worked: Enter the dates that contractor work on the project. 11. Contractor: Enter the name of the contractor receiving the contract. 12. Billing/Invoice Number: Enter invoice or billing number submitted by contractor. 13. Amount: Enter the total dollar figure listed on the invoice for that project. 14. Comments Scope: Enter a brief description of the work the contractor performed and/or other pertinent comments. 15. Grand Total (includes contract labor): Add the numbers in the Amount column and enter the result here.
Damage Assessment Manual by www.GreenAlert.net Applicant's Benefits Calculation Worksheet
Update 6/2/2004 8:51 AM
Benefits Calculation Fringe benefits for force account labor are eligible. Except in extremely unusual cases, fringe benefits for overtime will be significantly less than regular time. The following steps will assist in calculating the percentage of fringe benefits paid on an employee's salary. Note that items and percentages will vary from one entity to another.
1. The normal year consists of 2080 hours (52 weeks x 5 workdays/week x 8 hours/day). This does not include holidays and vacations. 2. Determine the employee's basic hourly pay rate (annual salary/2080 hours).
Fringe benefit percentage for vacation time: Divide the number of hours of annual vacation time provided
to the employee by 2080 (80 hours (2 weeks)/2080 3.85%).
Fringe benefit percentage for paid holidays: Divide the number of paid holiday hours by 2080 (64 hours (8
holidays)/2080 3.07%).
Retirement pay: Because this measure varies widely, use only the percentage of salary matched by the
employer.
Social Security and Unemployment Insurance: Both are standard percentages of salary. Insurance: This benefit varies by employee. Divide the amount paid by the city or county by the basic pay
rate determined in Step 2.
Workman's Compensation: This benefit also varies by employee. Divide the amount paid by the city or
county by the basic pay rate determined in Step 2. Use the rate per $100 to determine the correct percentage.
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Applicant's Benefits Calculation Worksheet (continued)

8. Workman's Compensation: This benefit also varies by employee. Divide the amount paid by the city or county by the basic pay rate determined in Step 2. Use the rate per $100 to determine the correct percentage. Note: Typically, the applicant should not be charging the same rate for regular time and overtime. Generally, only FICA (Social Security) is eligible for overtime; however, some entities may charge retirement tax on all income.
Sample Rates
Although some rates may differ greatly between organizations due to their particular experiences, the table below provides some general guidelines that can be used as a reasonableness test to review submitted claims. These rates are based on experience in developing fringe rates for several state departments, the default rate is that used for the state of Florida, following Hurricane Andrew, and the review of several FEMA claims. The rates presented are determined using the gross wage method applicable to the personnel hourly rate (PHR) method. The net available hours method would result in higher rates. Paid Fringe Benefits HCA Matching.......................7.65% (or slightly less) Retirement - Regular.............17.00% (or less) Retirement - Special Risk......25.00% (or slightly more) Health Insurance...................12.00% (or less) Life & Disability Insurance.....1.00% (or less) Worker's Compensation........3.00% (or less) Unemployment Insurance .....0.25% (or less) Leave Fringe Benefits Accrued Annual Leave ..........7.00% (or less) Sick Leave ............................4.00% (or less) Administrative Leave.............0.50% (or less) Holiday Leave .......................4.00% (or less) Compensatory Leave............2.00% (or less)
(Rates outside of these ranges are possible, but should be justified during the validation process)

FEMA Schedule of Equipment Rates
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The rates on this Schedule of Equipment Rates are for equipment in good mechanical condition, complete with all required attachments. Each rate covers all costs eligible under PL 93-288, as amended, for ownership and operation of equipment, including depreciation, all maintenance, field repairs, fuel, lubricants, tires, OSHA equipment and other costs incident to operation. Standby equipment costs are not eligible. Equipment must be in actual operation to be eligible. LABOR COSTS OF OPERATOR ARE NOT INCLUDED and should be approved separately from equipment costs. Information regarding the use of the schedule is contained in FEMA criteria. Rates for equipment not listed will be furnished by FEMA upon request. Any appeals shall be in accordance with 44 CFR 206. THESE RATES ARE APPLICABLE TO MAJOR DISASTERS AND EMERGENCIES DECLARED BY THE PRESIDENT AFTER THE DATE OF PUBLICATION OF THIS SCHEDULE. Cost Code
8010 8011 8012 8013 8014 8015 8016 8020 8021 8022 8023 8024 8025 8040 8041 8060 8070 8071 8072
Equipment
Air Compressor Air Compressor Air Compressor Air Compressor Air Compressor Air Compressor Air Compressor Air Curtain Burner Air Curtain Burner Air Curtain Burner Air Curtain Burner Air Curtain Burner Air Curtain Burner Ambulance Ambulance Auger, Portable Automobile Automobile, Police Automobile, Police
Capacity/ Size
125 Cfm 250 Cfm 450 Cfm 600 Cfm 750 Cfm 900 Cfm 1200 Cfm In Ground In Ground In Ground Above Ground Above Ground Above Ground
HP
to 65 to 95 to 150 to 200 to 240 to 260 to 325 to 30 to 60 to 90 to 30 to 60 to 90 to 150 to 210
Assumption
Hoses are included. Hoses are included. Hoses are included. Hoses are included. Hoses are included. Hoses are included. Hoses are included. In ground burner. In ground burner. In ground burner. Above ground burner. Above ground burner. Above ground burner.
Unit
hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour
Hourly Rate
$5.60 $9.25 $15.50 $20.00 $25.50 $29.00 $41.00 $4.80 $7.40 $9.75 $5.80 $8.25 $10.75 $13.75 $21.00 $0.70 $0.30 $0.35 $8.50
12 In
to 5 to 130 to 250 to 250 Mileage rate when transporting people. This is a mileage rate. Vehicle in a fixed position with the engine running and/or the warning lights flashing.
mile mile hour
8810 8820 8110 8111 8120 8050 8051 8131 8830
Backhoe, Small Backhoe, Large Barge, Deck Barge, Deck Barge, Hopper Board, Arrow, Trailer Board, Message, Trailer Boat Boat
See LoaderBackhoe See Hydraulic Excav. 7.25'x30'x120' 7'x45'x120' 12'x35'x195' to 8 to 5 5'x13' to 50 to 100 Includes outboards. Includes outboards and inboards. This is an open barge. hour hour hour hour hour hour hour $19.00 $28.50 $31.00 $1.50 $5.10 $7.20 $17.00

Cost Code
8831 8832 8833 8834 8840 8841 8842 8133 8134 8130 8132 8140 8141 8142 8143 8420 8421 8150 8151 8170 8171 8160 8180 8181 8180 8181 8182 8190 8200 8201 8202 8203 8204 8205 8206 8207 8210 8211 8220 Boat Boat Boat Boat Boat, Air Boat, Air Boat, Air Boat, Push Boat, Push Boat, Row Boat, Tender Boat, Tug Boat, Tug Boat, Tug Boat, Tug Breaker, Pavement Breaker, Pavement Broom, Pavement Broom, Pavement Broom, Pavement, Mtd Broom, Pavement, Mtd Broom, Pavement, Pull Bus Bus Bus Bus Bus Chain Saw Chipper Chipper Chipper Chipper Chipper Chipper Chipper Chipper Clamshell & Dragline Clamshell & Dragline Compactor 25 In 7 In 12 In 12 In 12 In 18 In 19 In 19 In to 30 to 65 to 125 to 171 to 250 to 350 to 475 to 650 to 128 to 250 to 10 72 In 84 In 72 In 72 In 84 In to 150 to 210 to 150 to 210 to 300 to 18 7'x14' 16 Ft 18 Ft 26 Ft 40 Ft to 75 to 100 to 175 to 250 to 380 to 80 to 137 to 32 to 90 16'x45' 21'x54'
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Equipment
Capacity/ Size
HP
to 150 to 200 to 250 to 300 to 100 to 200 to 300 to 435 to 525
Assumption
Includes outboards and inboards. Includes outboards and inboards. Includes outboards and inboards. Includes outboards and inboards.
Unit
hour hour hour hour hour hour hour hour hour
Hourly Rate
$22.00 $27.00 $33.00 $38.00 $12.00 $18.00 $28.00 $76.00 $103.00 $0.55 $13.50 $16.50 $26.00 $33.00 $81.00 $15.00 $31.00 $6.20 $9.75 $1.60 $2.50 $3.30 $9.50 $14.75 $9.50 $14.75 $20.00 $2.40 $5.90 $8.00 $12.00 $14.50 $24.50 $59.00 $63.00 $87.00 $67.00 $74.00 $3.20
This includes the oars.
hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour
Includes hand held and manually operated equipment.
hour

Cost Code
8221 8222 8223 8224 8225 8226 8227 8228 8230 8231 8232 8233 8250 8251 8252 8253 8254 8261 8262 8263 8280 8281 8282 8283 8284 8300 8301 8310 8311 8312 8313 8314 8315 8316 8317
Update 6/2/2004 8:51 AM
Equipment
Compactor Compactor Compactor Compactor Compactor Compactor Compactor Compactor, Towed Crane, Lifting Crane, Lifting Crane, Lifting Crane, Lifting Dozer, Crawler Dozer, Crawler Dozer, Crawler Dozer, Crawler Dozer, Crawler Dozer, Wheel Dozer, Wheel Dozer, Wheel Excavator, Hydraulic Excavator, Hydraulic Excavator, Hydraulic Excavator, Hydraulic Excavator, Hydraulic Fork Lift Fork Lift Generator Generator Generator Generator Generator Generator Generator Generator
Capacity/ Size
HP
to 50 to 80 to 110 to 150 to 186 to 210 to 318
Assumption
Unit
hour hour hour hour hour hour hour
Hourly Rate
$6.80 $11.25 $15.50 $21.00 $25.50 $42.00 $70.00 $1.00 $14.50 $36.00 $55.00 $81.00 $16.50 $21.50 $31.00 $40.00 $70.00 $38.00 $55.00 $89.00 $29.00 $34.00 $44.00 $57.00 $73.00 $4.50 $8.25 $1.20 $3.00 $6.00 $10.25 $15.50 $22.00 $26.50 $38.00
Drum 8 Tons 16 Tons 32 Tons 55 Tons to 80 to 150 to 210 to 325 to 70 to 115 to 160 to 240 to 310 to 210 to 310 to 454 0.5 CY 1.0 CY 1.5 CY 2.0 CY 2.5 CY 4000 Lbs 11000 Lbs 5 KW 15 KW 40 KW 65 KW 110 KW 125 KW 270 KW 400 KW to 50 to 100 to 11 to 30 to 57 to 92 to 160 to 200 to 390 to 570
Rate is for each drum.
hour hour hour hour hour hour hour hour hour hour
See 8260 for small wheel tractors/ dozers.
hour hour hour
Includes truck, crawler and wheel mtd eqmt. Includes truck, crawler and wheel mtd eqmt. Includes truck, crawler and wheel mtd eqmt. Includes truck, crawler and wheel mtd eqmt. Includes truck, crawler and wheel mtd eqmt.
hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour

Cost Code 8318 8319 8320 8330 8331 8332 8350 8351 8352 8353 8354 8355 8360 8370 8380 8381 8382 8383 8384 8385 8540 8541 8542 8390 8391 8392 8393 8394 8395 8396 8397 8570 Equipment Generator Generator Golf Cart Grader Grader Grader Hose Hose Hose Hose Hose Hose Jackhammer Lift, Scissor Loader, Crawler Loader, Crawler Loader, Crawler Loader, Crawler Loader, Crawler Loader, Crawler Loader, Skid Loader, Skid Loader, Skid Loader, Wheel Loader, Wheel Loader, Wheel Loader, Wheel Loader, Wheel Loader, Wheel Loader, Wheel Loader, Wheel Loader-Backhoe, Wheel 1500 Lbs 0.5 CY 1.0 CY 1.5 CY 2.0 CY 2.5 CY 3.0 CY 1000 Lbs 2000 Lbs 4000 Lbs 0.75 CY 1.0 CY 1.5 CY 2.0 CY 2.5 CY 3.0 CY 3.5 CY 4.0 CY 1.03 CY to 20 to 32 to 70 to 90 to 120 to 150 to 170 to 27 to 73 to 94 to 63 to 74 to 75 to 115 to 144 to 160 to 196 to 248 to 74 Capacity/ Size 500 KW 750 KW 2 Person 10' Blade 12' Blade 12' Blade 3 In 4 In 6 In 8 In 12 In 16 In to 100 to 140 to 200 Includes rigid and articulated equipment. Includes rigid and articulated equipment. Includes rigid and articulated equipment. HP to 715 to 1050 Assumption
Update 6/2/2004 8:51 AM
Unit hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour
Hourly Rate $56.00 $75.00 $1.80 $15.00 $25.00 $31.00 $0.05 $0.10 $0.15 $0.20 $0.35 $0.75 $0.60 $4.70 $7.75 $14.00 $17.50 $26.00 $35.00 $40.00 $4.90 $7.40 $15.50 $7.30 $9.75 $15.00 $18.00 $20.50 $25.00 $29.50 $36.00 $10.00
Discharge hoses for pumps. Suction hoses are included with pumps. Discharge hoses for pumps. Suction hoses are included with pumps. Discharge hoses for pumps. Suction hoses are included with pumps. Discharge hoses for pumps. Suction hoses are included with pumps. Discharge hoses for pumps. Suction hoses are included with pumps. Discharge hoses for pumps. Suction hoses are included with pumps. Hoses between air compressor and jackhammer are included in rate of air compressor.
Capacity is the loader bucket and not the backhoe bucket.
hour

Cost Code
8571 8572 8410 8411 8400 8401 8632 8430 8431 8432 8433 8434 8450 8440 8470 8471 8472 8473 8474 8475 8476 8463 8460 8461 8462 8510 8511 8512 8520 8521 8522 8640 8641 8610 8611 8612 8613
Update 6/2/2004 8:51 AM
Equipment
Loader-Backhoe, Wheel Loader-Backhoe, Wheel Mixer, Concrete, Port Mixer, Concrete, Port Mixer, Trailer Mounted Mixer, Trailer Mounted Mulcher, Trailer Mtd Paver, Asphalt Paver, Asphalt Paver, Asphalt Paver, Asphalt Paver, Asphalt Plow, Grader Mtd Plow, Truck Mtd Pump Pump Pump Pump Pump Pump Pump Pump Extender Pump, W/O Power Pump, W/O Power Pump, W/O Power Saw, Concrete Saw, Concrete Saw, Concrete Scraper Scraper Scraper Trailer, Office Trailer, Office Trailer, Water Trailer, Water Trailer, Water Trailer, Water
Capacity/ Size
1.5 CY 1.75 CY 6 CF 12 CF 6 CF 16 CF
HP
to 95 to 115 to 7 to 9 to 18 to 25 to 35
Assumption
Capacity is the loader bucket and not the backhoe bucket. Capacity is the loader bucket and not the backhoe bucket.
Unit
Hourly Rate
$14.50 $19.00 $1.50 $2.10 $3.80 $7.50 $4.80 $8.50 $19.50 $49.00 $65.00 $80.00 $6.90 $3.60 $2.10 $2.80 $6.00 $8.50 $12.75 $15.00 $17.50 $0.80 $1.50 $2.00 $4.70 $2.40 $5.70 $9.25 $47.00 $70.00 $102.00 $10.75 $12.75 $10.00 $12.75 $14.75 $16.50
8 Ft 8 Ft 10 Ft 10 Ft 10 Ft 10.5 Ft
to 35 to 71 to 130 to 200 to 234
Includes wheel and crawler equipment. Includes wheel and crawler equipment. Included wheel and crawler equipment. Includes wheel and crawler equipment. Includes wheel and crawler equipment.
2 In 3 In 4 In 6 In 8 In 10 In 12 In 20 Ft 6 In 12 In 24 In 14 In 26 In 36 In 11 CY 21 CY 31 CY 8 ' x 24 ' 8 ' x 32 ' 3000 Gal 6000 Gal 9000 Gal 12000 Gal
to 8 to 12 to 30 to 60 to 70 to 85 to 90 Extender for a Pump W/O Power
hour hour hour hour hour hour hour hour hour hour hour
to 20 to 35 to 65 to 180 to 330 to 450 Based on a daily rate. Based on a daily rate.
hour hour hour hour hour hour day day hour hour hour hour

Cost Code
8650 8651 8652 8653 8290 8710 8711 8712 8713 8680 8681 8720 8721 8722 8723 8690 8691 8692 8700 8701 8702 8730 8731 8714 8715 8803 8800 8801 8802 8790 8791 8792 8780 8781 8620 8621 8622
Update 6/2/2004 8:51 AM
Equipment
Trencher Trencher Trencher Trencher Trowel, Concrete Truck, Bucket Truck, Bucket Truck, Cleaning Truck, Cleaning Truck, Concrete Truck, Concrete Truck, Dump Truck, Dump Truck, Dump Truck, Dump Truck, Fire Truck, Fire Truck, Fire Truck, Flatbed Truck, Flatbed Truck, Flatbed Truck, Garbage Truck, Garbage Truck, Line Truck, Line Truck, Pick up Truck, Pick-up Truck, Pick-up Truck, Pick-up Truck, Tractor Truck, Tractor Truck, Tractor Truck, Water Truck, Water Tub Grinder Tub Grinder Tub Grinder
Capacity/ Size
HP
to 35 to 85 to 115 to 175
Assumption
Unit
hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour hour
Hourly Rate
$3.80 $15.50 $31.00 $49.00 $1.40 $12.50 $26.00 $19.00 $28.50 $39.00 $43.00 $14.25 $22.00 $26.00 $32.00 $24.50 $35.00 $45.00 $8.75 $11.25 $13.75 $26.00 $32.00 $26.00 $31.00 $0.30 $5.60 $6.30 $7.50 $18.50 $23.50 $26.00 $16.00 $19.00 $46.00 $63.00 $81.00
46 In 30 Ft 60 Ft 5 CY 14 CY 8 CY 12 CY 8 CY 10 CY 12 CY 18 CY
to 8 to 150 to 210 to 150 to 210 to 235 to 285 to 180 to 235 to 255 to 325 to 200 to 300 to 400
6000 Lbs 15000 Lbs 25000 Lbs 25 CY 32 CY
to 140 to 210 to 210 to 255 to 325 to 150 to 210
0.50 Ton 0.50 Ton 0.75 Ton 1.00 Ton 30000 Lbs 35000 Lbs 50000 Lbs 2000 Gal 3500 Gal
to 130 to 130 to 130 to 180 to 210 to 265 to 310 to 175 to 250 to 425 to 450 to 550
Mileage rate for transporting people. If vehicle was for hauling, etc. use hourly rate.
mile hour hour hour hour hour hour hour hour hour hour hour

Cost Code
8623 8624 8625 8321 8750 8761 8770 8771 8772
Update 6/2/2004 8:51 AM
Equipment
Tub Grinder Tub Grinder Tub Grinder Vehicle, Recreational Vehicle, Small Vibrator, Concrete Welder Welder Welder
Capacity/ Size
HP
to 650 to 800 to 1000 to 10 to 30 to 8
Assumption
Unit
hour hour hour
Hourly Rate
$102.00 $129.00 $147.00 $1.80 $3.40 $1.20 $1.90 $3.90 $5.60
Rate can be used for utility vehicles.
hour hour hour hour hour hour
200 Amp 300 Amp 400 Amp
to 16 to 34 to 50
Update 6/2/2004 8:51 AM

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Damage Assessment Manual by www.GreenAlert.

Update 6/2/2004 8:51 AM

Damage Assessment Manual by www.GreenAlert.net

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Table of ContentsAppendix A Forms

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Note: This page is intended to be blank

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Update 6/2/2004 8:51 AM

Business & Residential Structural Value Worksheet

Business & Residential Structural Value Worksheet

Typical Structure Value

$ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________ $ ________

Windshield Survey Form DA-1

County: _____________ City: _______________ Sub-division: ________________ Disaster Description __________________________

Survey Area Boundaries:

Surveyed By: _________________________ Title: ______________________ Phone: ________________ Date: ____________________

Destroyed Total Major Minor Affected

Not % Habitable Insurance

Single Family Structure

Multiple Family Structure

Damage Assessment Manual by www.GreenAlert.net

Update 6/2/2004 8:51 AM

Windshield Survey Form DA-1

Damage Assessment Manual by www.GreenAlert.net

Update 6/2/2004 8:51 AM

Damage Levels and Conditions for Windshield Survey

Conditions Present in Residential & Business Assessment

Affected but Habitable

Damage Assessment Manual by www.GreenAlert.net

Update 6/2/2004 8:51 AM

Program-Referenced Damage Levels

Minor Affected but Habitable Inaccessible

Minor Affected but Habitable Inaccessible

Minor Affected but Habitable Inaccessible

Damage Assessment Manual by www.GreenAlert.net

Update 6/2/2004 8:51 AM

Damage by Percent of Value

Habitable With Minimum Repair

Not Habitable or Destroyed

Figure 3.8 Structure Habitability and Percent of Value Charts

Figure 3.10 - Windshield SurveyIndividual Assistance Form IAF-1

Damage Assessment Manual by www.GreenAlert.net

Update 6/2/2004 8:51 AM

Individual Assistance Reporting Worksheet

RESIDENTIAL HOUSING Number Houses destroyed (ARC)

Primary Value (if Known) $ $

Secondary Number Value (if Known)

Mobile Homes Severely Damaged (ARC)

Mobile Homes Moderately Damaged (ARC)1 Mobile Homes Affected

Total Residential (primary plus secondary) BUSINESS

AGRICULTURE (from Form DA-BIZ-AG-1

TOTAL AGRICULTURE $ INDIVIDUAL DAMAGE TOTAL $

Site Estimate - Housing Losses

Name Ref Address # Phone

Damage Assessment Manual by www.GreenAlert.net

Amount of Insured Loss

Percent of Insured Loss

Update 6/2/2004 8:51 AM

Damage Assessment Manual by www.GreenAlert.net

$ $ $ $ $ $ $ $ $

County: _____ City: _ Sub-division: Disaster Description ________________

Surveyed By: ___ Title: Phone: Date:

Area __________________________ _ _______________________________

Type of Incident _________________ _ _ _______________________________

Transportation Need _____________ _ _ _______________________________

Nature of the Threat _____________ _ _______________________________

Nature of Protective Work ________ _ _______________________________

Impact _________________________ _ _______________________________

Local Response _________________ _ _______________________________

Rental Housing _ ______________

Mobile Homes ____________

Utilities _ ________ (

Construction Types _ __________________

Dwelling Types _ ______________

Dwelling Values _ _______________

Insurance Coverage _____________ _ _ _______________________________