Corps of Engineers Civil Works Questionnaires Generic Clearance

COMMERCIAL AND INDUSTRIAL FLOOD DAMAGE SURVEY

(Personal Interview)

OMB Control Number: 0710-0001

Expires: 30-Sep-2012

The public report burden for this information collection is estimated to average 40 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this data collection, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, and the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503, Attn.: Desk Officer for U.S. Army Corps of Engineers. Respondents should be aware that notwithstanding any other provision of law, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Please DO NOT RETURN your completed form to either of these offices.

COMMERCIAL AND INDUSTRIAL FLOOD DAMAGE SURVEY

OMB#: 0710-0001 Expires: 30-Sep-12

This survey is focused on damages that could occur to the contents of structures at your facility in the event of future flooding. Contents are defined as items that would be relocated in the event that the facility moves to another location, such as furniture, equipment, products, and raw materials. For this survey contents were divided in three categories:

• Equipment: Physical items that are used for the production process or the operation of the facility (e.g., generators, machinery, production tables, paint booths, robotics, racks, conveyors, floor scrubbers, computers/servers, etc.). These items would most likely be removed if the business relocates to another facility.

• Furniture: Physical items necessary for the conduct of business or delivery of a product (e.g., desks, chairs, bookcases, artwork, etc.). As with equipment, this category is focused on free-standing and attached furniture that would be removed in the event of relocation.

• Inventory/Products: Items that are used in the production process or result from the production process, or consumables used as part of the business activities. Items include raw materials, finished products, replacement parts, medical consumables, cleaning products, food, pharmaceuticals, software, building materials, office supplies, etc.

1. Type of business

2. Total number of buildings on site _____

3. Number of years business has been at this location _____

Flood History and Mitigation

4. Has your facility been flooded in the past? Yes No

If “Yes,” please complete Questions 5 and 6. If “No,” skip to Question 7.

5. 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:
Water depth above first floor:		Water depth above first floor:
Contents damage estimate ($):		Contents damage estimate ($):
Structure damage estimate ($):		Structure damage estimate ($):
Number of lost business days:		Number of lost business days:
Amount of lost net income ($):		Amount of lost net income ($):
Cost of cleanup ($):		Cost of cleanup ($):

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

Building Information

(Questions 7-17 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.)

7. Building #: ___________

8. Brief description of function of the building and its contents:

9. Year building was constructed: ________

10. Building Construction Type (e.g. brick):

11. Number of floors (including basement, if any):

12. Building footprint: __________ feet by __________ feet = ____________square feet

13. Does the building have a basement? Yes No If yes: _______ square feet finished area

_______ square feet unfinished area

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

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

January – March $ April – June $

July – September $ October – December $

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

Height (ft)	Equipment ($)	Furniture ($)	Inventory/products ($)
0.0 ft
1.0 ft
3.0 ft
6.0 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.

Susceptibility to Flood Damage

The amount of damage due to flooding can vary considerably depending on conditions (e.g., quality of water, duration of flood). When completing the following section, you will be asked to provide a range for potential damages. In addition to the most likely damage amount due to flooding, you will also be asked to provide a low and high estimate. Please use the following definitions:

• “Most Likely” – reasonable amount of damage expected to occur during an average flood.

• “Low” – reasonable low estimate of damages assuming that the flood conditions are less than a typical flood (e.g., short duration, relatively clean floodwaters) or the contents were less impacted than typically estimated (e.g., motors were sealed well).

• “High” – reasonable high estimate of damages assuming that the flood conditions are worse than a typical flood (e.g., long duration, highly contaminated floodwaters) or the contents were more impacted than typically estimated (e.g., motors need total replacement).

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

17. Please estimate damage to contents corresponding with water depths above/below the building’s 1^st 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
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

18. Other than the principal structures, are there any other valuable items on your property that flood waters could damage?

- 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 ($)

19. Emergency Measures/Plans:

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

b. What is the estimated cost to implement these emergency measures? $

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

COMMERCIAL AND INDUSTRIAL FLOOD DAMAGE SURVEY SUPPLIMENTAL SURVEY FORM

Firm Name:

This supplemental survey form is to be used for each additional building at your facility. Information for each building is needed to estimate damages that could occur to the contents of all structures at your facility in the event of future flooding.

7. Building #: ___________

8. Brief description of function of the building and its contents:

9. Year building was constructed: ________

10. Building Construction Type (e.g. brick):

11. Number of floors (including basement, if any):

12. Building footprint: __________ feet by __________ feet = ____________square feet

13. Does the building have a basement? Yes No If yes: _______ square feet finished area

_______ square feet unfinished area

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

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

January – March $ April – June $

July – September $ October – December $

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

Height (ft)	Equipment ($)	Furniture ($)	Inventory/products ($)
0.0 ft
1.0 ft
3.0 ft
6.0 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.

Susceptibility to Flood Damage

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

17. Please estimate damage to contents corresponding with water depths above/below the building’s 1^st 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
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.

3