OutdoorStructureObservationInstrument

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Outdoor Structural Visual Observation Instrument, Phase 2g

OMB Specification

Outdoor Structural Visual Observation Instrument

Event Category:	Time-Based
Event:	12M, 36M, 60M
Administration:	N/A
Instrument Target:	Child's Primary Residence
Instrument Respondent:	Data Collector
Domain:	Environmental
Document Category:	Observation
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	In-Person, CAI; Web-Based, CAI
Estimated Administration Time:	0 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0

​*This instrument is OMB-approved for multi-mode administration, but this version of the instrument is designed for administration in this/these mode(s) only.

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Outdoor Structural Visual Observation Instrument

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

GENERAL STRUCTURE 3

INTERIOR COMMON AREAS 5

EXTERIOR OF STRUCTURE 7

OTHER STRUCTURES 9

STRUCTURE GROUNDS DESCRIPTION 11

RECREATIONAL EQUIPMENT OR STRUCTURES 14

HOT TUBS/JACUZZIS 17

POOL 19

PONDS/FOUNTAINS 21

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Outdoor Structural Visual Observation Instrument

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

GENERAL STRUCTURE

(TIME_STAMP_GS_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD STRUCTURE_ID FOR THE STRUCTURE

• PRELOAD MULT_CHILD AND CHILD_NUM (IF MULT_CHILD = 1), FROM PVST INSTRUMENT.

• IF MULT_CHILD = 1, PRELOAD CHILD_QNUM

• ADMINISTER INSTRUMENT IF EVENT= 36-MONTH OR IF EVENT= 60-MONTH AND PARTICIPANT HAS MOVED SINCE THE 36-MONTH EVENT.

GS01000/(STAFF_ID). ENTER STAFF ID

__________________________________________

STAFF ID

GS02000. THESE OBSERVATIONS ARE ABOUT THE WHOLE STRUCTURE

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE GENERAL STRUCTURE OBSERVATIONS IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

GS03000/(STRUCT_TYPE). WHAT TYPE OF STRUCTURE IS THIS?

Label	Code	Go To
SINGLE FAMILY DWELLING	1	BUILD_USE
DUPLEX	2	BUILD_USE
MULTI-FAMILY DWELLING	3	BUILD_USE
TRAILER	4	BUILD_USE
GROUP HOME/DORMITORY	5	BUILD_USE
HOTEL/MOTEL	6	BUILD_USE
WORK CAMP	7	BUILD_USE
OTHER	-5

GS04000/(STRUCT_TYPE_OTH). SPECIFY:_______________________________________

GS05000/(BUILD_USE). IS THIS A MIXED USE BUILDING?

Label	Code	Go To
YES	1
NO	2

GS06000/(SECURE_STRUCT). IS THERE ANY ADDITIONAL SECURITY ADDED TO THE STRUCTURE?

Label	Code	Go To
YES	1
NO	2

GS07000/(NUMBER_FLOORS). WHAT IS THE NUMBER OF FLOORS WITHIN THE STRUCTURE?

|___|___|___|

NUMBER OF FLOORS

DATA COLLECTOR INSTRUCTIONS

• RECORD YOUR BEST ESTIMATE.

Label	Code	Go To
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• IF STRUCT_TYPE= 1, 2, OR 4 GO TO GEN_STRUCT_COMMENTS.

• OTHERWISE, GO TO STRUCT_UNITS

GS08000/(STRUCT_UNITS). HOW MANY DWELLING UNITS ARE THERE WITHIN THE STRUCTURE?

DATA COLLECTOR INSTRUCTIONS

• RECORD YOUR BEST ESTIMATE.

Label	Code	Go To
LESS THAN OR EQUAL TO 10	1
11—20	2
21—50	3
MORE THAN 50	4
DON’T KNOW	-2

GS09000/(GEN_STRUCT_COMMENTS). RECORD ANY COMMENTS ABOUT THE GENERAL STRUCTURE.

COMMENTS:___________________________________________________

(TIME_STAMP_GS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

INTERIOR COMMON AREAS

(TIME_STAMP_ICA_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

ICA01000. THESE OBSERVATIONS CONCERN THE INTERIOR COMMON AREAS ONLY.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF THE INTERIOR COMMON AREAS IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

ICA02000/(INT_COMMON). WHICH INTERIOR COMMON AREAS WERE OBSERVED?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
NO INTERIOR ROOMS/AREAS OBSERVED	1
HALLWAYS	2
LOBBY	3
LAUNDRY AREA	4
STORAGE AREA	5
RECREATION/MEDIA ROOM	6
LEASING OFFICE	7
MAIL ROOM	8
BATHROOM	9
GYM	10
OTHER	-5
NOT APPLICABLE	-7

PROGRAMMER INSTRUCTIONS

• IF INT_COMMON = -5 OR ANY COMBINATION OF 2 THROUGH 10 AND -5, GO TO INT_COMMON_OTH.

• IF INT_COMMON = 1 OR -7, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO INT_STRUCT_COMMENTS.

• OTHERWISE, GO TO ICA04000.

ICA03000/(INT_COMMON_OTH). SPECIFY: _______________________________________

ICA04000. INTERIOR COMMON AREA OBSERVATION INSTRUCTIONS

DATA COLLECTOR INSTRUCTIONS

• OBSERVE EACH INTERIOR COMMON AREA TO THE BEST OF YOUR ABILITY. IF AN AREA IS LOCKED OR OTHERWISE INACCESSIBLE, SIMPLY OBSERVE WHAT YOU CAN.

ICA05000/(INT_COMMON_SAFETY). WERE THERE ANY SAFETY ISSUES OBSERVED IN THE INTERIOR COMMON AREAS?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY

Label	Code	Go To
NO SAFETY HAZARDS OBSERVED	1
INADEQUATE LIGHTING	2
TRIP/FALL HAZARDS	3
NO FIRE EXTINGUISHERS	4
NO SPRINKLERS	5
EXITS NOT MARKED	6
UNVENTED CLOTHES DRYER	7
SHARP OBJECTS	8
COMMON AREAS NOT ACCESSIBLE	9
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF INT_COMMON_SAFETY = -5 OR ANY COMBINATION OF 2 THROUGH 9 AND -5, GO TO INT_COMMON_SAFETY_OTH.

• IF INT_COMMON_SAFETY = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO INT_STRUCT_COMMENTS.

• OTHERWISE, GO TO INT_STRUCT_COMMENTS.

ICA06000/(INT_COMMON_SAFETY_OTH). SPECIFY: _______________________________________

ICA07000/(INT_STRUCT_COMMENTS). RECORD ANY COMMENTS ABOUT THE INTERIOR COMMON AREAS

COMMENTS:___________________________________________________

(TIME_STAMP_ICA_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

EXTERIOR OF STRUCTURE

(TIME_STAMP_EOS_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

EOS01000. THESE OBSERVATIONS CONCERN HOW THE STRUCTURE APPEARS FROM THE OUTSIDE.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF THE EXTERIOR OF THE STRUCTURE IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

EOS02000/(EXT_DAM_STRUCT). DID YOU OBSERVE ANY MAJOR DAMAGE TO THE EXTERIOR OF THE STRUCTURE?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
NO MAJOR DAMAGE OBSERVED	1
DAMAGED SIDING	2
DAMAGED ROOF	3
FOUNDATION PROBLEMS	4
DAMAGED DECK AND PATIO	5
DAMAGED GUTTERS/DOWNSPOUTS	6
DAMAGED CHIMNEY	7
BROKEN WINDOWS	8
DAMAGED DOORS	9
EXTERIOR PAINT CHIPPING	10
GRAFFITI	11
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF EXT_DAM_STRUCT = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO EXT_DAM_STRUCT_COMMENTS.

• IF EXT_DAM_STRUCT= -5 OR ANY COMBINATION OF 2 THROUGH 11 AND -5, GO TO EXT_DAM_STRUCT_OTH.

• OTHERWISE, GO TO EXT_DAM_STRUCT_COMMENTS.

EOS03000/(EXT_DAM_STRUCT_OTH). SPECIFY: ______________________________________________________

EOS04000/(EXT_DAM_STRUCT_COMMENTS). RECORD ANY COMMENTS ABOUT THE EXTERIOR OF THE STRUCTURE.

COMMENTS:___________________________________________________

(TIME_STAMP_EOS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

OTHER STRUCTURES

(TIME_STAMP_OS_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

OS01000. THESE OBSERVATIONS CONCERN HOW ANY OTHER STRUCTURE (E.G., DETACHED GARAGE, SHED) APPEARS FROM THE OUTSIDE. IF THERE IS MORE THAN ONE OTHER STRUCTURE, SUCH AS BOTH A GARAGE AND A SHED, EVALUATE  BOTH STRUCTURES CONCURRENTLY, AND RECORD THE RESULTS IN THIS SECTION.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF OTHER STRUCTURES IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

OS02000/(OTH_STRUC_PRESENT). ARE THERE ANY OTHER STRUCTURES PRESENT?

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_OS_ET

OS03000/(MULTIPLE_OTHER_STRUCT). ARE THERE MULTIPLE OTHER STRUCTURES?

Label	Code	Go To
YES	1
NO	2

OS04000/(OTH_DAM_STRUCT). DID YOU OBSERVE ANY MAJOR DAMAGE TO THE OTHER STRUCTURE(S)?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

• IF ONE STRUCTURE DOES NOT HAVE ANY MAJOR DAMAGE, BUT THERE IS AN ISSUE WITH ANOTHER STRUCTURE, SELECT RESPONSES BASED ON YOUR OBSERVATIONS ABOUT THE DAMAGED STRUCTURE

Label	Code	Go To
NO MAJOR DAMAGE OBSERVED	1
DAMAGED SIDING	2
DAMAGED ROOF	3
FOUNDATION PROBLEMS	4
DAMAGED DECK AND PATIO	5
DAMAGED GUTTERS/DOWNSPOUTS	6
DAMAGED CHIMNEY	7
BROKEN WINDOWS	8
DAMAGED DOORS	9
EXTERIOR PAINT CHIPPING	10
GRAFFITI	11
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF OTH_DAM_STRUCT = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO OTH_ STRUCT_COMMENTS

• IF OTH_DAM_STRUCT = -5 OR ANY COMBINATION OF 2 THROUGH 11 AND -5, GO TO OTH_DAM_STRUCT_OTH.

• OTHERWISE, GO TO OTH_ STRUCT_COMMENTS.

OS05000/(OTH_DAM_STRUCT_OTH). SPECIFY: ______________________________________________________

OS06000/(OTH_ STRUCT_COMMENTS). RECORD ANY COMMENTS ABOUT THE EXTERIOR OF THE OTHER STRUCTURE(S)

COMMENTS: ___________________________________________________

(TIME_STAMP_OS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

STRUCTURE GROUNDS DESCRIPTION

(TIME_STAMP_SGD_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

SGD01000. THESE OBSERVATIONS CONCERN THE GROUNDS SURROUNDING THE STRUCTURE WITHIN 50 FEET OF THE HOME, OR TO AN OBVIOUS PROPERTY BOUNDARY LINE.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF THE GROUNDS OF THE STRUCTURE IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

SGD02000/(GROUND_DESC). DESCRIBE THE GROUNDS:

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
SIDEWALK	1
RESIDENTIAL YARD	2
STREET/ALLEY	3
FARM	4
UNIMPROVED LAND	5
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF GROUND_DESC= -5 OR ANY COMBINATION OF 1 THROUGH 5 AND -5, GO TO GROUND_DESC_OTH.

• OTHERWISE, GO TO GROUND_COVER.

SGD03000/(GROUND_DESC_OTH). SPECIFY: ______________________________________________________

SGD04000/(GROUND_COVER). WHAT TYPES OF GROUND COVER DID YOU OBSERVE?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
LAWN/GRASS	1
SOIL	2
HARD SURFACE	3
GRAVEL/PEBBLES	4
WOOD CHIPS/MULCH	5
SAND	6
DON’T KNOW	-2
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF GROUND_COVER= -5 OR ANY COMBINATION OF 1 THROUGH 6 AND -5, GO TO GROUND_COVER_OTH.

• IF GROUND_COVER= -2 DO NOT ALLOW SELECTION OF ANOTHER RESPONSE AND GO TO TREE_SHADE.

• OTHERWISE, GO TO TREE_SHADE.

SGD05000/(GROUND_COVER_OTH). SPECIFY: __________________________________________________

SGD06000/(TREE_SHADE). IS ANY PART OF THE YARD OF THE STRUCTURE SHADED BY TREES?

DATA COLLECTOR INSTRUCTIONS

• NOTE: DEPENDING ON THE SEASON, YOU MAY NEED TO IMAGINE THE YARD AREA AS COVERED BY SHADE FROM DECIDUOUS TREES.

Label	Code	Go To
NONE	1	POISON_PLANTS
LESS THAN 50 PERCENT	2
GREATER THAN OR EQUAL TO 50 PERCENT	3

SGD07000/(SHADE_DESC). WHAT KIND(S) OF TREES ARE THE SHADE TREES?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
DECIDUOUS	1
EVERGREEN	2
DON’T KNOW	-2

PROGRAMMER INSTRUCTIONS

• IF SHADE_DESC =-2, DO NOT ALLOW SELECTION OF ANY ADDITIONAL RESPONSES.

SGD08000/(POISON_PLANTS). ARE THERE ANY POISONOUS PLANTS IN THE YARD?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

SGD09000/(OUTSIDE_COMMENTS). RECORD ANY COMMENTS ABOUT THE GROUNDS SURROUNDING THE STRUCTURE.

COMMENTS:_______________________________________________________

(TIME_STAMP_SGD_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

RECREATIONAL EQUIPMENT OR STRUCTURES

(TIME_STAMP_REO_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

REO01000/(REO01000_INSTRUMENT). THESE OBSERVATIONS CONCERN RECREATIONAL EQUIPMENT THAT YOU OBSERVE WITHIN 50 FEET OF THE STRUCTURE OR WITHIN AN OBVIOUS PROPERTY BOUNDARY.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF RECREATIONAL EQUIPMENT OR STRUCTURES IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

REO02000/(STRANGULATION). WHAT STRANGULATION HAZARDS ARE PRESENT?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

• BE SURE TO RECORD ALL LOOP FORMING MATERIALS THAT CAN BE A POTENTIAL STRANGULATION HAZARD.

Label	Code	Go To
NO STRANGULATION HAZARDS OBSERVED	1
ROPES/JUMP ROPES	2
CLOTHESLINES	3
PET LEASHES	4
CORDS	5
HAMMOCK	6
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF STRANGULATION = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO PLAYGROUND_EQUIP.

• IF STRANGULATION = -5 OR ANY COMBINATION OF 2 THROUGH 6 AND -5, GO TO STRANGULATION_OTH.

• OTHERWISE, GO TO PLAYGROUND_EQUIP.

REO03000/(STRANGULATION_OTH). SPECIFY: _______________________________________________________

REO04000/(PLAYGROUND_EQUIP). WHAT TYPES OF PLAYGROUND EQUIPMENT ARE PRESENT?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
NO PLAYGROUND/PLAY EQUIPMENT	1
SWINGS/TIRE SWINGS	2
SLIDE	3
MONKEY BARS	4
TREE HOUSE	5
SAND BOX	6
PLAYHOUSE	7
TRAMPOLINE	8
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF PLAYGROUND_EQUIP = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO PLAYGROUND_COMMENTS.

• IF PLAYGROUND_EQUIP = -5 OR ANY COMBINATION OF 2 THROUGH 8 AND -5, GO TO PLAYGROUND_EQUIP_OTH.

• IF PLAYGROUND_EQUIP = 6 ONLY, GO TO PLAYGROUND_COMMENTS.

• OTHERWISE, GO TO LAND_SURF.

REO05000/(PLAYGROUND_EQUIP_OTH). SPECIFY: ____________________________________________________

REO06000/(LAND_SURF). WHAT TYPE OF LANDING SURFACE IS PRESENT?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

• LANDING SURFACE IS A PROTECTIVE SURFACE UNDER AND AROUND PLAYGROUND EQUIPMENT.

Label	Code	Go To
BARE GROUND	1
GRASS	2
GRAVEL	3
MULCH	4
CONCRETE/ASPHALT	5
SAND	6
RUBBER	7
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF LAND_SURF =-5 OR ANY COMBINATION OF 1 THROUGH 7 AND -5, GO TO LAND_SURF_OTH.

• OTHERWISE, GO TO PLAYGROUND_DAMAGE.

REO07000/(LAND_SURF_OTH). SPECIFY: _____________________________________________________

REO08000/(PLAYGROUND_DAMAGE). ARE THERE ANY HAZARDS OBSERVED ON THE PLAY EQUIPMENT?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
NO HAZARDS OBSERVED	1
PROTRUSION/PROJECTIONS	2
LARGE CRACKS	3
CHIPPING PAINT	4
LOOSE/WORN HARDWARE	5
DETERIORATED/EXPOSED FOOTINGS	6
OBSTRUCTION IN LANDING SURFACE	7
PLAY EQUIPMENT NOT STABLE	8
NO SAFETY NET ON TRAMPOLINE	9
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF PLAYGROUND_DAMAGE = 1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO PLAYGROUND_COMMENTS.

• IF PLAYGROUND_DAMAGE= -5 OR ANY COMBINATION OF 2 THROUGH 9 AND -5, GO TO PLAYGROUND_DAMAGE_OTH.

• OTHERWISE, GO TO PLAYGROUND_COMMENTS.

REO09000/(PLAYGROUND_DAMAGE_OTH). SPECIFY: ____________________________________________________________

REO10000/(PLAYGROUND_COMMENTS). RECORD ANY COMMENTS ABOUT THE RECREATIONAL EQUIPMENT OR STRUCTURES:

COMMENTS:__________________________________________________________

(TIME_STAMP_REO_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

HOT TUBS/JACUZZIS

(TIME_STAMP_HT_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

HT01000. THESE OBSERVATIONS CONCERN HOT TUBS AND JACUZZIS. ONLY OBSERVE HOT TUBS OR JACUZZIS PRESENT INSIDE OR OUTSIDE OF BUILDINGS BUT NOT IN THE DWELLING UNIT AND THOSE YOU SEE WHILE CONDUCTING OTHER ACTIVITIES OR OBSERVE WITHIN 50 FEET OF THE STRUCTURE OR WITHIN AN OBVIOUS PROPERTY BOUNDARY.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF HOT TUBS/JACUZZI IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

HT02000/(HOT_TUB_PRES). ARE THERE ANY HOT TUBS/JACUZZIS PRESENT?

Label	Code	Go To
YES	1
NO	2	HOT_TUB_COMMENTS

HT03000/(HOT_TUB_LOC). WHAT IS THE LOCATION OF THE HOT TUB/JACUZZI?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
INDOORS	1
OUTDOORS	2
IN-GROUND	3
ABOVE-GROUND	4

HT04000/(HOT_TUB_SAFE). DID YOU OBSERVE ANY HOT TUB/JACUZZI SAFETY HAZARDS?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THATAPPLY.

• IF THERE ARE MULTIPLE HOT TUBS/JACUZZIS, AND ONE DOES NOT HAVE ANY HAZARDS BUT THERE IS A HAZARD WITH ANOTHER, SELECT RESPONSES BASED ON YOUR OBSERVATIONS ABOUT THE HOT TUB/JACUZZI WITH HAZARDS. 

Label	Code	Go To
NO HAZARDS OBSERVED	0
NO LOCKED ENTRANCE	0
NO DRAIN COVER	0
NO FOUR-SIDED FENCING/BARRIER	0
ELECTRICAL HAZARDS	0
PROTRUSION/PROJECTIONS	0
TRIP/FALL/SLIP HAZARDS	0
UNSECURED POTENTIAL POISONS	0
OTHER	0

PROGRAMMER INSTRUCTIONS

• IF HOT_TUB_SAFE = 1 DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO HOT_TUB_COMMENTS

• IF HOT_TUB_SAFE = -5 OR ANY COMBINATION OF 2 THROUGH 8 AND -5, GO TO HOT_TUB_SAFE_OTH.

• OTHERWISE, GO TO HOT_TUB_COMMENTS

HT05000/(HOT_TUB_SAFE_OTH). SPECIFY: ____________________________________________________

HT06000/(HOT_TUB_COMMENTS). RECORD ANY COMMENTS ABOUT THE HOT TUBS/JACUZZIS:

COMMENTS:__________________________________________________________

(TIME_STAMP_HT_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

POOL

(TIME_STAMP_PO_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PO01000. THESE OBSERVATIONS CONCERN POOLS ONLY. OBSERVE POOLS PRESENT INSIDE OR OUTSIDE OF BUILDINGS BUT NOT IN THE DWELLING UNIT AND THOSE YOU SEE WHILE CONDUCTING OTHER ACTIVITIES OR OBSERVE WITHIN 50 FEET OF THE STRUCTURE OR WITHIN AN OBVIOUS PROPERTY BOUNDARY.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF POOLS IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

PO02000/(POOL_PRES). IS THERE A POOL PRESENT?

Label	Code	Go To
YES	1
NO	2	POOL_COMMENTS

PO03000/(POOL_LOC). WHAT IS THE LOCATION OF THE POOL?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
INDOORS	1
OUTDOORS	2
IN-GROUND	3
ABOVE-GROUND	4

PO04000/(POOL_SAFE). DID YOU OBSERVE ANY POOL SAFETY HAZARDS?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

• IF THERE ARE MULTIPLE POOLS (FOR EXAMPLE, ADULT AND CHILD POOLS), AND ONE DOES NOT HAVE ANY HAZARDS BUT THERE IS A HAZARD WITH ANOTHER, SELECT RESPONSES BASED ON YOUR OBSERVATIONS ABOUT THE POOL WITH HAZARDS.

Label	Code	Go To
NO HAZARDS OBSERVED	1
NO LOCKED ENTRANCE	2
NO DRAIN COVER	3
NO FOUR-SIDED FENCING/BARRIER	4
ELECTRICAL HAZARDS	5
PROTRUSION/PROJECTIONS	6
TRIP/FALL/SLIP HAZARDS	7
UNSECURED POTENTIAL POISONS	8
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF POOL_SAFE =1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO POOL_COMMENTS.

• IF POOL_SAFE =-5 OR ANY COMBINATION OF 2 THROUGH 8 AND -5, GO TO POOL_SAFE_OTH.

• OTHERWISE, GO TO POOL_COMMENTS.

PO05000/(POOL_SAFE_OTH). SPECIFY: _____________________________________________________

PO06000/(POOL_COMMENTS). RECORD ANY COMMENTS ABOUT THE POOL(S):

COMMENTS:__________________________________________________________

(TIME_STAMP_PO_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PONDS/FOUNTAINS

(TIME_STAMP_PON_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PON01000. THESE OBSERVATIONS CONCERN PONDS AND FOUNTAINS ONLY. OBSERVE PONDS AND FOUNTAINS PRESENT INSIDE OR OUTSIDE OF BUILDINGS BUT NOT IN THE DWELLING UNIT AND THOSE YOU SEE WHILE CONDUCTING OTHER ACTIVITIES OR OBSERVE WITHIN 50 FEET OF THE STRUCTURE OR WITHIN AN OBVIOUS PROPERTY BOUNDARY.

DATA COLLECTOR INSTRUCTIONS

• PERFORM THE OBSERVATIONS OF PONDS/FOUNTAINS IN ACCORDANCE WITH THE SOP FOR ENVIRONMENTAL OUTDOOR STRUCTURAL VISUAL OBSERVATIONS.

PON02000/(POND_PRES). IS THERE A POND/FOUNTAIN PRESENT?

Label	Code	Go To
YES	1
NO	2	POND_COMMENTS

PON03000/(POND_LOC). WHAT IS THE LOCATION OF THE POND/FOUNTAIN?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
INDOORS	1
OUTDOORS	2
IN-GROUND	3
ABOVE-GROUND	4

PON04000/(POND_SAFE). DID YOU OBSERVE ANY POND/FOUNTAIN SAFETY HAZARDS?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

• IF THERE ARE MORE THAN ONE POND/FOUNTAIN, AND ONE IS FINE BUT THERE IS A HAZARD WITH ANOTHER, SELECT RESPONSES ACCORDING TO THE ONE WITH HAZARDS.

Label	Code	Go To
NO HAZARDS OBSERVED	1
NO LOCKED ENTRANCE	2
NO DRAIN COVER	3
NO FOUR-SIDED FENCING/BARRIER	4
ELECTRICAL HAZARDS	5
PROTRUSION/PROJECTIONS	6
TRIP/FALL/SLIP HAZARDS	7
UNSECURED POTENTIAL POISONS	8
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF POND_SAFE =1 DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO POND_COMMENTS.

• IF POND_SAFE =-5 OR ANY COMBINATION OF 2 THROUGH 8 AND -5, GO TO POND_SAFE_OTH.

• OTHERWISE, GO TO POND_COMMENTS

PON05000/(POND_SAFE_OTH). SPECIFY: ___________________________________________________

PON06000/(POND_COMMENTS). RECORD ANY COMMENTS ABOUT THE PONDS/FOUNTAINS:

COMMENTS:____________________________________________________

(TIME_STAMP_PON_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP