Corps of Engineers Civil Works Questionnaires Generic Clearance

NONRESIDENTIAL FLOOD DAMAGE SURVEY

(Personal Interview)

OMB 0710-0001

Expires: 30 September 2012

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NONRESIDENTIAL FLOOD DAMAGE QUESTIONNAIRE

1. What year was your business established at this location? __________

2. Briefly describe the major purpose of this business facility? _______________

______________________________________________________________

3. How many buildings are there at this facility? _______________

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

_________ ________ _______________

Full Time Part Time Total Employees

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

______ Shifts per day

6. While at this location, approximately how many times has this facility

experienced flood damage, including the flooding from ­­­­­­­the (date) floods?

_________ Times

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

__________ DAYS

7a. Did your business set up temporary quarters at another location because of the (date) floods?

1. NO

2. YES

7b. How much additional money did the flood cost your business in increased operational expenses, such as temporary quarters, additional transportation, communications, or storage expenses?

$______

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

1. TV

2. RADIO

3. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

4. TELEPHONE BY OTHER

5. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

6. FACE TO FACE BY OTHER

7. LOUDSPEAKER

8. SIREN

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

10. NEWSPAPER

11. OBSERVING THE CREEK OR RIVER WATER LEVELS

12. OTHER ______________________________________

8a. How many hours were there between the time you became aware that flooding might reach your business until the water actually reached your property?

______ HOURS

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

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

(PLEASE CIRCLE ALL THAT APPLY AND INDICATED THE DOLLARS DAMAGES PREVENTED FOR EACH ACTION.)

Damage Preventive Action	Took Preventive Action	Dollar Damage Prevented
1. Moved contents to higher ground
2. Elevated contents to a higher spot in the building
3. Shut off electrical equipment
4. Sandbagged the outside of the building
5. Used another type of temporary barrier
6. Moved vehicles to higher ground
7. Other action _______________________
8. None

To be filled out by the interviewer:

1. What is the four-digit North American Standard Industrial Classification Number for this business?

_________________

2. What is the Marshall-Swift Occupancy Code for this business?

__________________

PART TWO

INDIVIDUAL BUILDING DATA

(Include one sheet for each building)

1. Building Number ________

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

physically attached or anchored to this building, not including

the building itself? $________

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

equipment, furniture, supplies, raw materials, and inventory

generally stored in this building? $________

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

vehicles generally stored at this building? $________

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

other equipment, supplies, and inventory stored outside of,

but in the immediate vicinity of this building? $________

3. Please indicate how high in feet and inches that the water got on

the inside of the building relative to the first floor of the building?

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

[CIRCLE]

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

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

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

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

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

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

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

TYPE OF DAMAGE	AMOUNT OF COST OR DAMAGE
STRUCTURE DAMAGE	$__________________
CONTENT DAMAGE	$__________________
VEHICLE DAMAGE	$__________________
PREVENTIVE COSTS	$__________________
CLEANUP COST	$__________________
LANDSCAPING AND OUTSIDE PROPERTY	$__________________
UNPAID HOURS OF TIME FOR CLEAN AND REPAIR	____________ UNPAID HOURS
BUSINESS RECORD REPLACEMENT COSTS	$__________________ ____________ UNPAID HOURS

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

_____________ DAYS ____________ HOURS

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

_______________ STORIES

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

_______________ FEET

12. What year was this building constructed? ___________________

13. What is the shape of this building?

1. Square

2. Rectangular

3. L-shaped

4. U-shaped

5. Very Irregular

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

___________ SQUARE FEET

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

1. Electric 9. Ventilation 17. Complete HVAC

2. Electric Wall 10. Wall Furnace 18. Evaporative Cooling

3. Forced Air 11. Package Unit 19. Refrigerated Cooling

4. Hot Water 12. Warmed and Cooled Air

5. Hot Water, Radiant 13. Hot and Chilled Water

6. Space Heater 14. Heat Pump

7. Steam 15. Floor Furnace

8. Steam, Without Boiler 16. Individual Thruwall

Heat Pump

16. Does this building have a basement?

0. NO

1. YES

16a. If yes, please indicate the total basement area, and the area in square feet or dimensions of the area that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

Total Area: ________________ Square Feet

Finished Area: _____________ Square Feet

Unfinished Area: ___________ Square Feet

To be filled out by the interviewer:

1. What is the 5-digit zip code of this business? _________________

2. Indicate the class of this building.

Circle the appropriate letter.

A. Fireproof Structural Steel Frame

B. Reinforced Concrete Frame

C. Masonry Bearing Walls

D. Wood or Steel Stud Framed Exterior Walls

S. Metal Frame Walls

M. Mill Type Construction

P. Pole Frame Construction

3. Indicate the rank (quality) of this building?

1. Low

2. Average

3. Above Average or Good

4. High Cost or Excellent

4. What is the effective age of this building?

_______ Years

5. How many passenger elevators are in this building?

_______ Passenger Elevators

6. How many freight elevators are in this building?

_______ Freight Elevators

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