Flood Risk Management Survey

AGRICULTURAL FLOOD DAMAGE

Background Information

1. How many years have you operated a farm at this location?

Years

2. Does part of your farm flood frequently enough to require a change in cropping patterns?

1. No 2. Yes

3. How many acres are there in this frequently flooded area?

Acres

Crop Distribution and Production Practices

4. Crop Distribution/Yield Without Project:

In the area below, please describe the cropping patterns for the upper and lower areas of your farm under existing flood conditions. The lower areas are those areas subject to flooding frequently enough to cause a change in cropping patterns.

EXISTING CONDITONS
	LOWER AREA		UPPER AREA
Crop	Acres	Yield in Bushels or Bales	Acres	Yield in Bushels or Bales
Cotton
Soybeans
Rice
Wheat
Grain Sorghum (Milo)
Corn
Alfalfa
Hay
Pasture
Fallow
Other Specify ___________
Other Specify ___________

5. How many times since you first operated this farm has flooding caused delayed planting or replanting?

Times

6. How many times since you first operated this farm has flooding made you unable to harvest a crop?

Times

7. Please indicate the usual date for each stage of crops production activity.

Crop	Usual Beginning Plant Date for Production Practices			Last date to Plant
	Date to Begin Land Preparation	Date to Begin Planting	Date to Begin Harvesting

Crops Damage

8. Please fill in the following regarding the most recent flood.

8a. Date that flooding began: _______________ (month, day, year)

8b. Depth of flooding at deepest point: ____________ (feet)

8c. Longest duration of flooding at any part of your yard: _____________ (days)

9. DAMAGE TO CROPS AND PASTURE FROM FLOODING
Crop	No. of Acres	Yield/Acre After Flood	If flooding made it too late to plant this crop, what did you plant instead?	What additional production costs, if any, did you have because of the flooding?	What production costs did you NOT have because of the flooding?

Farm Property Damage

10. Please use the table below to identify the amount of damage for each non-crop item for the most recent flood event. Do not include any property related to fish production.

Item	Unit	Units Damaged	Total Estimated Damage in $
Farm Roads	Linear Feet
Drainage Ditches	Linear Feet
Fences	Linear Feet
Land Leveling	Acres
Land Damage	Acres
Equipment	Pieces of Equipment
Farm Buildings	Number of Buildings
Stored Feeds	Bushels
Pasture	Acres
Other

Fishpond Damage

11. Do you have any fishponds?

_____Yes _____No

If no, the questionnaire is completed.

12. If yes, have you ever incurred damage to your fishponds as a result of flooding?

_____Yes _____No

If no, the questionnaire is completed.

If yes, 13. What was the date of this last damaging flood to your fishponds?

_________________________________

14. If yes, how many acres of fishpond area were damaged?

Acres

15. Please list below the amount of dollar losses or damages during the most recent flooding that damaged your fishponds?

CATEGORY	($) LOSSES OR DAMAGES TO AQUACULTURE PROPERTY FROM FLOODING
Fish that Were Ready for Market
Pre-market Fish
Levees
Feed for Fish
Equipment
Miscellaneous
Total Damages

COASTAL STORM DAMAGE

Background Information

1. Is this your primary residence?

1. NO

YES

1a. If not, is it a… (CIRCLE ONE ANSWER)

1. Second Home

2. Rental

3. Other (PLEASE SPECIFY)________________________________________

2. How many years have you owned this house?

________________ YEARS

3. How old is your home?

________________ YEARS OLD

Approximately how many times has your home had coastal storm damage since you’ve lived here, including Hurricane __(Name)______ or the coastal storm of __(date)______?

______ TIMES

5. Where is your home situated? (CHECK ONE)

____ Oceanfront, if so how many feet is your home from the ocean at mean high water line?

_______ Feet

____ First row behind oceanfront

____ Ocean block (Within a block of the ocean)

____ On a sound or back bay

____ Interior, (More than a block from the ocean bay, or sound)

Structural and Outside Property Data

6. Not counting your attic, garage, or the under portion of an elevated building how many square feet of living area are in your home? (If you are unsure, please give the dimensions.)

___________ SQUARE FEET or (_______FEET X __________ FEET)

7. What type of foundation does your home have?

(PLEASE CIRCLE ONE ANSWER AND INDICATE NUMBER OF FEET, WHERE APPROPIATE)

1. Slab

2. Piling - If piling, how many feet do they go below ground? ______ Feet

3. How many feet do they elevate the structure above ground? ______ Feet

4. Concrete Block –

If so, How many feet do they go below ground? ______ Feet

5. Other type of foundation, please describe. ________________________________________________________

8. If you have an elevated building, is there an under-the-house enclosure?

(CIRCLE YES OR NO)

YES NO

If yes, please indicate the size of enclosed area devoted to each of the following uses:

8a. Finished living area: ___________ SQUARE FEET or (_______FEET X __________ FEET)

8b. Utility space ___________ SQUARE FEET or (_______FEET X ________ FEET)

8c. Garage: ___________ SQUARE FEET or (_______FEET X __________ FEET)

8d. Other: Please describe: __________________________________________________

____________SQUARE FEET or (_______FEET X __________ FEET)

9. Do you have an attached garage that is not under the house?

(CIRCLE YES OR NO) YES NO

9a. If so, indicate the size of the attached garage.

____________SQUARE FEET or (_______FEET X __________ FEET)

10. Do you have a detached garage that is not under the house?

(CIRCLE YES OR NO) YES NO

10a. If so, indicate the size of the detached garage.

____________SQUARE FEET or (_______FEET X __________ FEET)

11. What category best describes the style of this building?

(CIRCLE ONE ANSWER)

1. One-Story 5. 1-1/2 Story Finished 9. 3-1/2 Story Finished

2. Two-Story 6. 1-1/2 Story Unfinished 10. 3-1/2 Story Unfinished

3. Three-Story 7. 2-1/2 Story Finished 11. Bi-Level

4. Split Level 8. 2-1/2 Story Unfinished

12. Not counting any basement, attic, or garage, how many square feet of living area are in your home? (If respondent is unsure, ask for the dimensions and calculate.)

___________ SQUARE FEET

13. Does your home have a basement? (CIRCLE)

1. NO (Skip to 14)

2. YES

13a. If yes, please indicate the total basement area, in square feet, and the amount that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

TOTAL BASEMENT AREA: ________________ SQUARE FEET

FINISHED BASEMENT AREA: _____________ SQUARE FEET

UNFINISHED BASEMENT AREA: __________ SQUARE FEET

14. Do you have a carport? (CIRCLE)

1. NO

2. YES

14a. How large is the carport in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

15. What category best describes the heating and cooling system in this building?

(CIRCLE ONE ANSWER FOR MOST PROMINENT SYSTEM)

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water

Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System

Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

16. What is the primary exterior wall covering on this building?

(CIRCLE ONE ANSWER)

1. Plywood 4. Siding 7. Common Brick

2. Hardboard 5. Shingle 8. Face Brick

Sheets 6. Masonry 9. Stone

3. Stucco Veneer 10. Concrete Block

17. What is the primary roof covering of this building? (CIRCLE ONE ANSWER)

1. Composition Shingle 5. Concrete Tile 10. Plastic Tile

2. Built-up Rock 6. Clay Tile

3. Wood Shingle 7. Galvanized Metal

(Embedded in Asphalt) 8. Slate

4. Wood Shake 9. Composition Roll

18. How many fireplaces are in this home? _________ FIREPLACES

_______ FIREPLACES

19. How many square feet of each of the following types of porches are there in this home? (If you are unsure of square feet, please give dimensions.)

Slab ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Slab with Roof ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Wood Deck ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Slab Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Wood Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

20. Do you have an elevator in your home?

___ Yes ___ No

21. How high is the first floor of your building above the lowest adjacent grade?

________FEET

22. How high is the first floor of your building above the where flood water would first enter your building (from considering windows and pipes into the foundation?

________FEET

23. Please note any long-term flood proofing method, which may be used on this property.

(Please circle yes or no for each column.)

Long-Term Flood Proofing Methods	Original Construction	Retrofitted (after original construction)	Was Method Effective?
Elevated Construction	YES NO	YES NO	YES NO
Reinforced piling	YES NO	YES NO	YES NO
Extended piling	YES NO	YES NO	YES NO
Bracing	YES NO	YES NO	YES NO
Sealant or Shield What type? _______________________	YES NO	YES NO	YES NO

24. Please indicate 1) which utilities are elevated in your home in order to prevent flood damage and 2) indicate whether the elevating was effective:

(Please circle yes or in both columns.)

Utility	Elevated	Was method effective?
Air Conditioner	Yes No	Yes No N/A
Furnace	Yes No	Yes No N/A
Washer/Dryer	Yes No	Yes No N/A
Water Heater	Yes No	Yes No N/A
Other:	Yes No	Yes No N/A

25. Other than in the under-the-house enclosure, do you have a garage on this property? (CIRCLE)

1. NO (Skip to 26)

2. YES

25a. Is the garage attached to the structure? (CIRCLE)

1. NO

2. YES

25b. How large is the garage in square feet? (If you are unsure, please give the dimensions.)

_________ SQUARE FEET Or ( ____ Feet X ___ Feet)

26. How high is the first floor of your building above the lowest adjacent grade?

________FEET

COSTS AND DAMAGES

The next group of questions is to determine damages to different types of property from the Hurricane __(NAME)_ or the coastal storm of ( DATE ).

27. Please indicate how high (in feet and inches) did any standing water in your home reach relative to the first floor of your home?

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

28. Please indicate how high in feet and inches did any waves reach relative to the first floor of your home?

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

29. Please indicate the primary source of damage to your home, excluding wind damage?

(CIRCLE ONE)

1. STORM SURGE (a sudden flow of water associated with a storm event)

2. WAVE RUNUP (the rush of water up a structure, associated with the breaking of a wave)

3. INUNDATION (the buildup of water overflow or ponding)

4. EROSION

5. OTHER _______________________________

30. Did the flooding from this storm make it necessary for you or other occupants of your home to stay in temporary residence due to evacuation or while your home was being repaired?

(CIRCLE)

1. NO (Skip to 31)

2. YES

30a. How many days did you or other occupants of your home to spend in temporary residence due to the evacuation or while flood damage to your home was being repaired?

_____ DAYS

30b. How much money did your household spend beyond your normal travel expense, on travel and lodging due to your evacuation(s) during Hurricane _(Name)_?

______ DOLLARS

30c. Due to your evacuation, how much money did your household spend on food in excess of what you normally would have spent?

______ DOLLARS

31. Was there erosion damage to your lot?

31a. If so, how many square feet of your lot were eroded?

_______ Square Feet?

31b. What percentage of the lot directly under your home (footprint of your home) was eroded?

_______ Percent

31c. What were the total costs to repair the erosion damage to your lo/t and your home?

$ __________

32. For each motor vehicle, (including sedan, vans, sports utility, sports cars, station wagons, pickup trucks, boats, jet skis, golf carts, and motorcycles) located at this residence during the flood, please indicate the dollar value, whether or not it was moved, the dollar amount of damage to the vehicle, if any, and the level, in feet and inches, that the flood water reached above the bottom of the vehicle’s wheels.

Motor Vehicle Category and Year (Categories include: sedan, vans, sports utility, sports cars, station wagons, pickup trucks, boats, jet skis, golf carts, and motorcycles)	Dollar Value	Was it Moved to a safe location? (CIRCLE YES OR NO)	Dollar Damage	Depth of Water from the Bottom of the Vehicle
Vehicle 1:	$_______	YES NO	$_______	______ FEET
Vehicle 2:	$_______	YES NO	$_______	______ FEET
Vehicle 3:	$_______	YES NO	$_______	______ FEET

The following questions are to determine the dollar cost and unpaid hours for repair and cleanup of your home, and repair, replacement, and cleanup to the contents of your home that resulted from Hurricane _(NAME)_.

33. What was the cost of the structural damage to your home? (Structural damage is defined as damage to any building components, including foundation, walls, floors, windows, roof, electrical systems, heating and cooling systems, plumbing, attached carpeting, attached shelves and cabinets, and built-in equipment and appliances.)

$_______________ DOLLAR COSTS OF STRUCTURE DAMAGE

33a. Which of the following is the primary source of your structure damage repair costs?

(Circle one)

1. Contractor estimate (before repairs)

2. Contractor invoice (after repairs)

3. Your own assessment

4. Other _______________________

33b. What was the dollar cost to you for labor and supplies to clean up your home after the hurricane?

$________

33c. What was the total number of unpaid hours that you and others spent on repair and cleanup to your home?

______ UNPAID HOURS

34.		Please itemize your total structural damages and any additional time that was spent on repairs other than paid labor hours into the following categories.
	Portion of Structure		Value of Damages
			In % of total Or in Dollars		Unpaid Hours to repair or install, in addition to $ spent
	1. Built-in shelves and appliances		_____%	$______	__________ UNPAID HOURS
	2. Electrical		_____%	$______	__________ UNPAID HOURS
	3. Plumbing		_____%	$______	__________ UNPAID HOURS
	4. Exterior walls, windows, doors (painting included), and roofing		_____%	$______	__________ UNPAID HOURS
	5. Footings and foundation		_____%	$______	__________ UNPAID HOURS
	6. Interior doors and walls (painting included)		_____%	$______	__________ UNPAID HOURS
	7. Interior floors, carpet and ceilings		_____%	$______	__________ UNPAID HOURS
	8. Mechanical systems - heat, A/C, sump pump, built-in vacuum		_____%	$______	__________ UNPAID HOURS
	Porches and decks		_____%	$______	__________ UNPAID HOURS
	Chimneys and fireplaces		_____%	$______	__________ UNPAID HOURS
	12. Garages and outbuildings		_____%	$______	__________ UNPAID HOURS
	13. Outside property and landscaping		_____%	$______	__________ UNPAID HOURS
	14. Septic, sewer, and water systems		_____%	$______	__________ UNPAID HOURS
	Total		100 %	$______	__________ UNPAID HOURS

35. What was the dollar damage to the contents of your home, garage, and shed, excluding motor vehicles? (Only include content replacement and repairs. Do not include repairs to the structure of the house).

$___________________

(Content damage refers to damage to personal property kept inside the home or the garage that is not permanently affixed to the home.)

36. What was the total number of unpaid hours that you and others spent on repair of appliances, furniture, and other contents of your home?

______ UNPAID HOURS

37. How much, if anything, did each of the following cost you in actual dollar expenditures as a result of Hurricane (NAME) ?

a) Costs for moving furniture and other belongings? $___________

b) Costs for storing furniture and other belongings? $___________

c) Vandalism, looting, or theft costs? $___________

d) Costs from flooding-related medical problems? $___________

e) Any other costs due to Hurricane ________. $___________

Describe: ______________________________ $___________

______________________________________ $___________

38. Is there a swimming pool on your lot?

____Yes ____No, Go to Question 39

38a. Was your swimming pool damaged by Hurricane (NAME) ?

____Yes ____No, Go to Question 39

38b. What were your repair costs from Hurricane (NAME) associated with your swimming pool? (If the pool was destroyed, please estimate the replacement cost.)

$_____________ SWIMMING POOL REPAIR COSTS

38c. What are the dimensions of your swimming pool?

Size Range of Depth

___ feet X ___feet _____feet at shallowest point ______ feet at deepest point

38d. Is your swimming pool on the oceanfront side of your home?

______Yes ______No

39. List any additional features, such as hot tub, tile works, etc. that may have been damaged by Hurricane (NAME) .

Item $ Damage CIRCLE N/A, IF NOT APPLICABLE

HOT TUB $__________ N/A

TILE WORK $__________ N/A

DECKING $__________ N/A

OTHER (SPECIFY_________________) $__________ N/A

Flood Warning and Response

40. Just before (DATE) storm, how did you first become aware that flooding might reach your business? (CIRCLE ONE ANSWER)

1. E-MAIL

2. TEXT MESSAGE

3. TWITTER

4. WEBSITE

5. TV

6. RADIO

7. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

8. TELEPHONE BY OTHER

9. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

10. FACE TO FACE BY OTHER

11. LOUDSPEAKER

12. SIREN

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

14. NEWSPAPER

15. OBSERVING THE CREEK OR RIVER WATER LEVELS

16. OTHER ______________________________________

41. How many hours were there between the time you first became aware that flooding might reach your property until when the water actually reached your property?

______ HOURS

42. 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 YES OR NO FOR EACH ACTION LISTED BELOW AND INDICATE THE DOLLARS DAMAGES PREVENTED FOR EACH ACTION.)

Damage Preventive Action	Took Preventive Action	Dollar Damage Prevented (PLEAS FILL IN $ DAMAGES PREVENTED OR CIRCLE DK FOR DON’T KNOW.)
1. Moved contents to higher ground	YES NO	$__________ OR DK
2. Elevated contents to a higher spot in the building	YES NO	$__________ OR DK
3. Shut off electrical equipment	YES NO	$__________ OR DK
4. Sandbagged the outside of the building	YES NO	$__________ OR DK
5. Used another type of temporary barrier	YES NO	$__________ OR DK
6. Moved vehicles to higher ground	YES NO	$__________ OR DK
7. Other action _______________________ _______________________	YES NO	$__________ OR DK
8. None	YES NO

43. Emergency Measures/Plans:

41a. What emergency measures/plans, if any, would you take to reduce damage if you were forewarned of another coastal storm?

43b. What is your estimated cost to implement these emergency measures?

$

43c. How much time (in man hours) is required to implement these emergency measures?

MAN HOURS

NONRESIDENTIAL

Background Information

1. Briefly describe the major purpose of this business facility? ________________

______________________________________________________________________

2. What is the total number of buildings on site _____ Buildings

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

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

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

__________ DAYS CLOSED

8a. Did your business set up temporary quarters at another location because of the (date) floods? (CIRCLE)

1. NO

2. YES

8b. How much additional money did the flood cost your business in increased operational expenses, such as temporary quarters, additional transportation, communications, or storage expenses?

$____________ Total Additional Dollars

8c. Please describe additional costs. ___________________________________________________________________

___________________________________________________________________

Individual Building Information

(Questions 9-21 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.)

9. Brief description of function of the primary building and its contents:

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

physically attached or anchored to this building, not including

the building itself? $________

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

equipment, furniture, supplies, raw materials, and inventory

generally stored in this building? $________

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

vehicles generally stored at this building? $________

13. 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? $________

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

_______________ STORIES

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

_______________ FEET

16. What year was this building constructed? ___________________

17. What is the shape of this building? (Circle one answer.)

1. Square

2. Rectangular

3. L-shaped

4. U-shaped

5. Very Irregular

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

___________ SQUARE FEET

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

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water

Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System

Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

20. Does this building have a basement? (CIRCLE)

0. NO

1. YES

20a. 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

21. Please indicate the primary construction material for the building frame.

___Block/Brick ___Steel ___Wood ___Metal

(Check appropriate block)

22. 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
8.0 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.

Physical Damage and Other Costs

23. How high in feet and inches did the water from ______ (year) flood reach on the inside of this building relative to the first floor of the building?

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

[CIRCLE]

24. 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:	__________
Contents damage estimate ($):	$_________	Contents damage estimate ($):	$_________
Structure damage estimate ($):	$_________	Structure damage estimate ($):	$_________
Number of lost business days:	______Days	Number of lost business days:	______Days
Amount of lost net income ($):	$_________	Amount of lost net income ($):	$_________
Cost of cleanup ($):	$_________	Cost of cleanup ($):	$_________

25. Please indicate the replacement value and damage or costs that you attribute to each of the following items.

		Replacement Value	Actual Damage or Cost
Damage to Transportation
Rail beds and tracks		$_________	$_____________________
Docks and loading facilities		$_________	$_____________________
Damage to Buildings
Foundation and supports		$_________	$_____________________
Floors (mark one) ___Steel ___Concrete ___Wood		$_________	$_____________________
Floor covering (mark one) ___Ceramic ___Linoleum ___Carpet		$_________	$_____________________
Exterior walls and insulation (mark one) ___Metal ___Wood ___Block/brick		$_________	$_____________________
Windows		$_________	$_____________________
Interior walls and ceilings		$_________	$_____________________
Doors and moldings		$_________	$_____________________
Damage to Building Utilities Indicate location: B=Basement, G=Ground floor, I=Intermediate floors, R=Roof	Replacement Value		(year)Flood Actual Damage or Cost
Sewer systems ___Storm ___Industrial ___Sanitary ___B ___G ____I ___R	$_________		$_____________________
Water supply systems ___Treatment ___Pipes ___B ___G ____I ___R	$_________		$_____________________
Water systems ___Hot water ___Softening ___B ___G ____I ___R	$_________		$_____________________
Communications systems ___B ___G ____I ___R	$_________		$_____________________
Electric power transformers ___Pole ___Ground	$_________		$_____________________
Electrical service entrance and meters ___B ___G ____I ___R	$_________		$_____________________
Engines/generators/alternators ___B ___G ____I ___R	$_________		$_____________________
Other Electrical control panels and circuit breakers ___B ___G ____I ___R	$_________		$_____________________
Wiring switches, outlets, lighting ___B ___G ____I ___R	$_________		$_____________________
Fuel supply ___Oil tanks ___Gas pipes/meters ___B ___G ____I ___R	$_________		$_____________________
Heating ___Oil ___Gas ___Elect. ___Air ___Water ___B ___G ____I ___R	$_________		$_____________________
Air conditioning ___Gas ___Electric ___Cool ___Purify ___Dehumidify ___B ___G ____I ___R	$_________		$_____________________
Damage to Equipment, Appliances, and Furniture
___Conveyors ___Elevators ___Escalators	$_________		$_____________________
Foundry furnaces and welding equipment	$_________		$_____________________
Machine tools and patterns	$_________		$_____________________
Other motors and engines	$_________		$_____________________
Compressors	$_________		$_____________________
Built-in refrigeration units	$_________		$_____________________
Hand and paint tools	$_________		$_____________________
Other equipment	$_________		$_____________________
Display cases, counters, and bins	$_________		$_____________________
Appliances ___Oven ___Refrigerators ___Other _____________________	$_________		$_____________________
Vehicles kept at this location	$_________		$_____________________
Damage to:
Parts/raw materials	$_________		$_____________________
Partly assembled/processed product	$_________		$_____________________
Inventory	$_________		$_____________________
General Costs
Fighting the Flood			$_____________________
Evacuation ___Owner ___Tenant			$_____________________
Number of employees out of work			____________ Unemployed
Value of lost wages			$_____________________
Removal of debris and damaged items			$_____________________
Disinfecting, other cleaning and rehabilitation			$_____________________
Replacement of records			$_____________________
Loss of gross income due to interruption of business			$_____________________
Loss of net income due to interruption of business			$_____________________
Increased alternative operating costs			$_____________________

26. 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 were 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	$_________________________________

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

_____________ DAYS _____________ HOURS

Damage Susceptibility

28. 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

29. Please estimate the range in damage to contents at corresponding water depths above/below the building’s 1^st floor elevation. (Express damage in either $ or % of total value at the lower and upper ends as well as the most likely estimate.)

Flood Depth	Equipment			Furniture				Inventory/products
	Lower End	Most Likely	Upper end		Lower End	Most Likely	Upper End	Lower End	Most Likely	Upper End
-6.0 ft
-3.0 ft
-1.0 ft
0.0 ft
0.5 ft
1.0 ft
3.0 ft
6.0 ft
Total*

* Total should equal 100% in each column if you are reporting as % of total value.

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.

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

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

January – March $ April – June $

July – September $ October – December $

31. Other than the principal structures, are there any other valuable items on your property that flood waters could damage, such as 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 ($)

Flood Warning and Response

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

1. E-MAIL

2. TEXT MESSAGE

3. TWITTER

4. WEBSITE

5. TV

6. RADIO

7. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

8. TELEPHONE BY OTHER

9. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

10. FACE TO FACE BY OTHER

11. LOUDSPEAKER

12. SIREN

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

14. NEWSPAPER

15. OBSERVING THE CREEK OR RIVER WATER LEVELS

16. OTHER ______________________________________

32a. How many hours were there between the time you became aware that flooding might reach your business until the water actually reached your business property?

______ HOURS

33. 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 YES OR NO FOR EACH ACTION LISTED AND INDICATE THE DOLLARS DAMAGE PREVENTED FOR EACH ACTION.)

Damage Preventive Action	Took Preventive Action (CIRCLE)	Dollar Damage Prevented $____ or Circle DK for Don’t Know
1. Moved contents to higher ground	Yes No	$_________ DK
2. Elevated contents to a higher spot in the building	Yes No	$_________ DK
3. Shut off electrical equipment	Yes No	$_________ DK
4. Sandbagged the outside of the building	Yes No	$_________ DK
5. Used another type of temporary barrier	Yes No	$_________ DK
6. Moved vehicles to higher ground	Yes No	$_________ DK
7. Other action: _____________________________	Yes No	$_________ DK
8. None	Yes No	$_________ DK

34. Emergency Measures/Plans:

34a. What emergency measures/plans, if any, would you take to reduce damage if you were forewarned of eminent flooding?

34b. What is your estimated cost to implement these emergency measures?

$

34c. How much time in man hours is required to implement these emergency measures?

MAN HOURS

PUBLIC DAMAGES AND OTHER COSTS

1. Name of Governmental Entity: _______________________________

2. Agency: ______________________________________

3. Phone Number: ______________________________________

4. Dates of Flooding/

Coastal Storm: ______________________________________

5. Source(s) of Flooding: ______________________________________

6. In the table below list the damages that occurred to public property in your jurisdiction as a result of the (date) flood.

Type of Property	$ Damage	Primary Cause of Damage (inundation, wave, erosion, etc.)
Buildings	$____________
Equipment	$____________
Vehicles	$____________
Supplies	$____________
Streets, highways, roads	$____________
Water supply system plant and equipment distribution system	$____________
Sewage system plant and equipment distribution system	$____________
Drainage system	$____________
Bridges	$____________
Docks	$____________
Marinas	$____________
Boardwalks	$____________
Parks	$____________
Other	$____________

7. Please list any other public cost that resulted from the flooding in your jurisdiction.

Type of Costs	$ Costs	Volunteer (unpaid hours)
Emergency operations and floodfighting	$________________________	________ Hours
Police protection	$________________________	________ Hours
Additional costs of water supply	$________________________	________ Hours
Additional costs of sewage treatment	$________________________	________ Hours
Additional costs of flood cleanup	$________________________	________ Hours
Additional costs of trash collection and disposal	$________________________	________ Hours
Replacement of business records	$________________________	________ Hours
Repairs to levee, sand dunes, or other flood or coastal protection	$________________________	________ Hours
Cleanup of hazard waste	$________________________	________ Hours
Other costs	$________________________	________ Hours
Total	$________________________	________ Hours

8. Please describe any harmful public health and other environmental effects that flooding may have caused by inundation of landfills, sewage treatment plants, or other hazardous waste sites.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

If you had a damaged sewage treatment facility in the most recent flood, please answer questions 9-13. (If not, skip to question 14.)

9. What is the capacity of the damage facility in gallons per day?

_______________ Gallons per Day

10. What is the estimated replacement cost of the plant?

$_________________

11. How high did the water get above the lowest ground elevation of the plant?

_____________ FEET

12. What was the repair cost to the plant?

$_______________

13. How many days was the plant not operating because of the flood damage?

________________ DAYS

If you had a damaged WATER treatment facility in the most recent flood, please answer questions 9-13. (If not, the survey is complete.)

14. What is the capacity of the damage facility in gallons per day?

_______________ Gallons per Day

15. What is the estimated replacement cost of the plant?

$_________________

16. How high did the water get above the lowest ground elevation of the plant?

_____________ FEET

17. What was the repair cost to the plant?

$_______________

18. How many days was the plant not operating because of the flood damage?

________________ DAYS

RESIDENTIAL

Background and Flood History

1. How many years have you been living at this address?

___________ years

2. Were you living at this residence during the (year) flood?

___NO ___YES

3. Was your residence flooded during the (year) flood?

___NO ___YES

4. Before the most recent flood, what would you have said the chance was of major flooding that would cause an evacuation of your neighborhood? (check one)

___NO CHANCE

___SLIGHT CHANCE

___MODERATE CHANCE

___STRONG CHANCE

___EXTREMELY LIKELY CHANCE

5. Before the flood this year, had your home ever been flooded? (check one)

___NO (SKIP to Q7) ___YES

6. Please give me the year that any previous floods occurred, and check whether or not you evacuated your home each time.

YEAR

______ ___ DID NOT EVACUATE ___EVACUATED

______ ___ DID NOT EVACUATE ___EVACUATED

______ ___ DID NOT EVACUATE ___EVACUATED

______ ___ DID NOT EVACUATE ___EVACUATED

______ ___ DID NOT EVACUATE ___EVACUATED

Structural Data

7. What is the five-digit zip code of this home?

_____________

8. What category best describes the style of this building?

(CIRCLE ONE ANSWER)

1. One-Story 5. 1-1/2 Story Finished 9. 3-1/2 Story Finished

2. Two-Story 6. 1-1/2 Story Unfinished 10. 3-1/2 Story Unfinished

3. Three-Story 7. 2-1/2 Story Finished 11. Bi-Level

4. Split Level 8. 2-1/2 Story Unfinished

9. Not counting your basement, attic, or garage, how many square feet of living area are in your home? (If respondent is unsure, ask for the dimensions and calculate.)

___________ SQUARE FEET

10. Does your home have a basement? (CIRCLE)

1. NO (Skip to 11)

2. YES

10a. If yes, please indicate the total basement area, in square feet, and the amount that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

TOTAL BASEMENT AREA: ________________ SQUARE FEET

FINISHED BASEMENT AREA: _____________ SQUARE FEET

UNFINISHED BASEMENT AREA: __________ SQUARE FEET

11. Do you have a garage on this property? (CIRCLE)

1. NO (Skip to 12)

2. YES

11a. Is the garage attached to the structure? (CIRCLE)

1. NO

2. YES

11b. How large is the garage in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

12. Do you have a carport? (CIRCLE)

1. NO

2. YES

12a. How large is the carport in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

13. What category best describes the heating and cooling system in this building?

(CIRCLE ONE ANSWER FOR MOST PROMINENT SYSTEM)

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water

Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System

Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

14. What is the primary exterior wall covering on this building?

(CIRCLE ONE ANSWER)

1. Plywood 4. Siding 7. Common Brick

2. Hardboard 5. Shingle 8. Face Brick

Sheets 6. Masonry 9. Stone

3. Stucco Veneer 10. Concrete Block

15. What is the primary roof covering of this building? (CIRCLE ONE ANSWER)

1. Composition Shingle 5. Concrete Tile 10. Plastic Tile

2. Built-up Rock 6. Clay Tile

3. Wood Shingle 7. Galvanized Metal

(Embedded in Asphalt) 8. Slate

4. Wood Shake 9. Composition Roll

16. How many fireplaces are in this home? _________ FIREPLACES

_______ FIREPLACES

17. How many square feet of each of the following types of porches are there in this home? (If you are unsure of square feet, please give dimensions.)

Slab ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Slab with Roof ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Wood Deck ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Slab Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Wood Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

18. Do you have an elevator in your home?

___ Yes ___ No

19. How high is the first floor of your building above the lowest adjacent grade?

________FEET

20. How high is the first floor of your building above the where flood water would first enter your building (from considering windows and pipes into the foundation?

________FEET

Cost and Damages

The next group of questions is to determine flood damages to different types of property from the ___(year_______ flood.

21. Please indicate how high in feet and inches that the water was relative to the first

floor of the inside of your home.

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

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

_____________ DAYS ____________ HOURS

23. Did the flooding make it necessary for you or other members of your household to stay in temporary residence due to evacuation or while your home was being repaired?

(CIRCLE)

1. NO (Skip to 24)

2. YES

23a. How many days did you spend in temporary residence due to the evacuation or while flood damage to your home was being repaired?

_____ DAYS

23b. How much money did your household spend on travel, (beyond your normal travel expense), and lodging (including trailer rental) due to your evacuation(s) for the ___________ flood?

______ DOLLARS

23c. Due to your evacuation, how much money did your household spend on food in excess of what you normally would have spent?

______ DOLLARS

24. For each motor vehicle, including cars, trucks, recreational vehicles, boats, and motorcycles, located at this residence during the flood, please indicate the dollar value, whether or not it was moved, the amount of damage to the vehicle, if any, and the level, in feet and inches, that the flood water reached above the bottom of the vehicle’s wheels.

Vehicle Category and Year (Categories include: sedan, van, sports utility, sports cars, pickup trucks, and motorcycles)	Dollar Value	Was it Moved? (Yes or no)	Dollar Damage	Depth of Water from the Bottom of the Vehicle
Vehicle 1:	$ ________	YES NO	$ ________	_______ FEET
Vehicle 2:	$ ________	YES NO	$ ________	_______ FEET
Vehicle 3:	$ ________	YES NO	$ ________	_______ FEET
Vehicle 4:	$ ________	YES NO	$ ________	_______ FEET

The following questions are to determine the dollar cost and unpaid hours for repair and cleanup of your home, and repair, replacement, and cleanup to the contents of your home that resulted from the __(YEAR)__ flood.

25. What was the cost of the structural damage to your home resulting from the (Year) flood? (Structural damage is defined as damage to any building components; including foundation, walls, floors, windows, roof, electrical systems, heating and cooling systems, plumbing, attached carpeting, attached shelves and cabinets, and built-in equipment and appliances.)

$_______________

25a. Which of the following is the primary source of your structure damage repair cost?

(circle one)

5. Contractor estimate (before repairs)

6. Contractor invoice (after repairs)

7. Your own assessment

8. Other _______________________

25b. What was the dollar cost to you for labor and supplies to clean up your home after the flood?

$________

25c. What was the total number of unpaid hours that you and others spent on repair and cleanup to your home after the flood?

______ UNPAID HOURS

26. a.	Please list your total real estate damages into the following categories.
b.	Please also itemize any additional time that was spent on repairs other than paid labor hours.

Area of Damage	Value of Damages
	In % of total Or in dollars		Unpaid Hours to repair or install, in addition to $ spent
1. Built-in shelves and appliances	%	$	________ UNPAID HOURS
2. Electrical	%	$	________ UNPAID HOURS
3. Plumbing	%	$	________ UNPAID HOURS
4. Exterior walls, windows, doors (painting included), and roofing	%	$	________ UNPAID HOURS
5. Footings and foundation	%	$	________ UNPAID HOURS
6. Interior doors and walls (painting included)	%	$	________ UNPAID HOURS
7. Interior floors, carpet and ceilings	%	$	________ UNPAID HOURS
8. Mechanical systems - heat, A/C, sump pump, built-in vacuum	%	$	________ UNPAID HOURS
9. Outbuildings, decks, fireplaces and garages	%	$	________ UNPAID HOURS
10. Outside property and landscaping	%	$	________ UNPAID HOURS
11. Septic, sewer, and water systems	%	$	________ UNPAID HOURS
Total	100 %	$	________ UNPAID HOURS

CONTENT DAMAGE

Content damage refers to damage to personal property kept inside the home or the garage that is not permanently affixed to the home.

27. What was the dollar cost of flood damage to the contents of your home, garage, and shed, excluding motor vehicles? (Only include content replacement and repairs, do not include repairs to the structure of the house).

$___________________

28. What was the total number of unpaid hours that you and others spent on repair of appliances, furniture, and other contents of your home?

______ UNPAID HOURS FOR CONTENT REPAIR

29. How much, if anything, did each of the following cost you in actual dollar expenditures as a result of the __(YEAR)__ flood?

a) Costs for moving furniture and other belongings? $__________

b) Costs for storing furniture and other belongings? $__________

c) Vandalism, looting, or theft costs? $__________

d) Costs from flooding-related medical problems? $__________

e) Any other costs due to the _______ flood. $__________

Describe: __________________________________________

__________________________________________________

Flood Warning and Response

30. Just before this year’s flood, did anyone at this residence hear from anyone or receive any other communication that flooding was possible? (CHECK ONE)

___NO (SKIP to Q48) ___YES

31. Did the FIRST such message that you received include any of the following information?

a) "Conditions are possible for a flood in your community." 1. NO 2. YES

b) "Watch the river or stream for flooding." 1. NO 2. YES

c) "It's possible your home will be flooded." 1. NO 2. YES

d) "Flooding will occur; take action." 1. NO 2. YES

e) "Evacuate your home." (no instructions) 1. NO 2. YES

f) "Evacuate your home." (with instructions) 1. NO 2. YES

g) The time that flooding would occur. 1. NO 2. YES

h) Other information in the message. 1. NO 2. YES

(Specify:)________________________________________________

32. What would you call this first message that you received? (circle one)

1. A FLOOD WATCH

2. A FLOOD WARNING

3. NEITHER ONE

4. UNSURE

33. On what date and at what time of day did you hear this message?

MO. DAY TIME (Hours and Minutes):

__/ __/ __:___ (circle one): AM or PM

34. How did you receive this first message? (CIRCLE ONLY ONE)

1. E-MAIL

2. TEXT MESSAGE

3. TWITTER

4. WEBSITE

5. TV

6. RADIO

7. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

8. TELEPHONE BY OTHER

9. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

10. FACE TO FACE BY OTHER

11. LOUDSPEAKER

12. SIREN

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

14. NEWSPAPER

15. OBSERVING THE CREEK OR RIVER WATER LEVELS

16. OTHER ______________________________________

35. On what date, and at what approximate time, did the flood waters reach your property? [Put a Number on each Blank or Check [ ] if DON'T KNOW]

DATE TIME (Hours and Minutes):

__________ __: ___ (circle one): AM or PM

[ ] DON'T KNOW

36. Of each of the following actions, please answer yes or no to each to indicate the actions that you took, if any, as a result of this first message you heard. Remember that these are only actions with respect to the first message you heard.

[CIRCLE YES OR NO FOR EACH.]

In response to the first message did you :

a) Listen to TV or Radio? 0. NO 1. YES

b) Contact family members? 0. NO 1. YES

c) Contact other people? 0. NO 1. YES

d) Disconnect appliances? 0. NO 1. YES

e) Pack or prepare any household possessions

for an evacuation? 0. NO 1. YES

f) Elevate possessions above the floor of the first

story of your house? 0. NO 1. YES

g) Move any possessions to a safer location

outside of the house? 0. NO 1. YES

h) Go out and look at the stream? 0. NO 1. YES

I) Move cars or other vehicles to higher ground? 0. NO 1. YES

j) Evacuate from the structure? 0. NO 1. YES

k) Take any other actions? (if yes, list below) 0. NO 1. YES

_______________________________________________

37. On a scale of 1 to 10 how would you estimate the strength of your belief in this first message? (1 represents total disbelief and 10 represents total belief)

­­­__________ (fill-in with number between 1-10)

38. The previous questions asked about the first message you received. Did you receive a DIFFERENT MESSAGE LATER ON indicating that flooding was possible or the possibility of flooding had increased?

0. NO If No, SKIP to Q 48

1. YES

39. Did the SECOND message that you received include any of the following information?

a) "Conditions possible for a flood

in your community." 0. NO 1. YES

b) "Watch the river or stream for flooding." 0. NO 1. YES

c) "It is possible your home will be flooded." 0. NO 1. YES

d) "Flooding will occur; take action." 0. NO 1. YES

e) "Evacuate your home." (no instructions) 0. NO 1. YES

f) "Evacuate your home." (with instructions) 0. NO 1. YES

g) The time that flooding would occur. 0. NO 1. YES

h) Other information in the message. 0. NO 1. YES

(Specify:)_______________________________________

40. What would you call this SECOND message that you received? (circle one)

1. A FLOOD WATCH

2. A FLOOD WARNING

3. NEITHER ONE

4. UNSURE

41. On what date, and what time of day did you hear this message?

MO. DAY TIME (Hours and Minutes):

__/ __/ __:___ (circle one): AM or PM

42. How did you hear this SECOND message? (circle one only)

1. E-MAIL

2. TEXT MESSAGE

3. TWITTER

4. WEBSITE

5. TV

6. RADIO

7. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

8. TELEPHONE BY OTHER

9. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

10. FACE TO FACE BY OTHER

11. LOUDSPEAKER

12. SIREN

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

14. NEWSPAPER

15. OBSERVING THE CREEK OR RIVER WATER LEVELS

16. OTHER ______________________________________

43. Please answer yes or no to each to indicate which of the following actions, if any, that you took as a result of this SECOND message that you heard.

[CIRCLE YES OR NO FOR EACH.]

In response to the second message did you :

a) Listen to TV or Radio? 0. NO 1. YES

b) Contact family members? 0. NO 1. YES

c) Contact other people? 0. NO 1. YES

d) Disconnect appliances? 0. NO 1. YES

e) Pack or prepare any household possessions for

evacuation? 0. NO 1. YES

f) Elevate possessions above the floor of the first story

of your house? 0. NO 1. YES

g) Move any possessions to a safer location outside

of the house? 0. NO 1. YES

h) Go out and look at the stream? 0. NO 1. YES

I) Move cars or other vehicles to higher ground? 0. NO 1. YES

j) Did the SECOND message cause you to evacuate

from the structure? 0. NO 1. YES

k) Did the SECOND message cause you to take

any other actions? (If yes, list below) 0. NO 1. YES

____________________________________________________________________­­­­­­

44. On a scale of 1 to 10 how would you estimate the strength of your belief in this second message? (1 = total disbelief, and 10 = total belief)

­­­__________ (fill-in with number between 1-10)

45. After receiving the second message, did you receive any later messages that caused you to take further action?

0. NO If No, SKIP to Q 48.

1. YES

2. UNSURE

46. Please describe the (those) later message(s).

____________________________________________________

____________________________________________________

47. What additional actions, if any, did you take as a result of hearing the (those) later message(s)?

____________________________________________________

____________________________________________________

->48. Do you have any suggestions on ways to improve the current flood warning system?

_____________________________________________________________________

_____________________________________________________________________

49. For each of the following categories, please tell me the total number of people who were in the residence, the number who did evacuate, and the number who did not: (Put a Number or Zero on each Blank)

EVAC- DID

TOTAL UATED NOT

a) Household members under 13: _____ _____ _____

b) Household members 13-64 yrs. old: _____ _____ _____

c) Household members 65 and over: _____ _____ _____

--------------------------------------------------------------------

d) Non-household members < 13: _____ _____ _____

e) Non-household members 13-64 yrs. old: _____ _____ _____

f) Non-household members 65 and over: ___­­­­__ _____ _____

[SKIP to Q 54 , if no one evacuated.]

50. During the flooding this year, how many people evacuated from your household using each of the following modes of transportation?

[Put a Number or Zero on each blank.]

Number Evacuating

a) CAR OR TRUCK? ________

b) BOAT? ________

c) WALKING? ________

d) OTHER TRANSPORTATION? ________

(What kind?)___________________________________

51. For you and others who decided to evacuate from your residence, which of the following affected the decision to evacuate? Please answer yes or no to each.

[CIRCLE YES OR NO FOR EACH.]

Did you evacuate because of:

a) Messages on TV or Radio? 0. NO 1. YES

b) A telephone message from friends or relatives? 0. NO 1. YES

c) A face to face message from friends or relatives? 0. NO 1. YES

d) Telephone messages from local officials? 0. NO 1. YES

e) Face to face messages from local officials? 0. NO 1. YES

f) Experience you or other residents had with floods

in previous years? 0. NO 1. YES

g) High stream level or flood waters close to

your residence? 0. NO 1. YES

h) Because it was physically impossible to remain

in the structure? 0. NO 1. YES

I) To find or meet family members? 0. NO 1. YES

j) Because the neighbors were evacuating? 0. NO 1. YES

k) Other Reason(s) for Decision to Evacuate? 0. NO 1. YES

[Probe for Reasons]______________________________________

52. On what date, and at what time of day, did you last leave your house to go to a place of safety?

Date _____________________________

MO. DAY TIME (Hours and Minutes):

__/ __/ __:___ (circle one): AM or PM

53. How much time did it take in your evacuation to get out of the area of flood danger?

[Put a Number or a Zero on each Blank]

_____HOURS; ______MINUTES

Check Box if everyone evacuated [ ], and SKIP to Q31.

->54. If you and others did NOT evacuate when warned, which of the following affected your decision NOT to evacuate or to delay doing so?

[CIRCLE YES OR NO FOR EACH.]

a) Did not believe messages on TV or Radio? 0. NO 1. YES

b) Telephone message from friends or relatives? 0. NO 1. YES

c) Face to face message from friends or relatives? 0. NO 1. YES

d) Telephone messages from local officials? 0. NO 1. YES

e) Face to face messages from local officials? 0. NO 1. YES

f) Experience you or other residents had with floods in

previous years? 0. NO 1. YES

g) Location of flood waters in relation to the residence? 0. NO 1. YES

h) Because it was physically impossible to

leave the structure? 0. NO 1. YES

I) Because of the location of your family members? 0. NO 1. YES

j) Because the neighbors were not evacuating? 0. NO 1. YES

k) Fear of looting? 0. NO 1. YES

l) Other Reason(s) for Not Evacuating? 0. NO 1. YES

[specify]__________________________________________________________

The next question is to determine how you learned about the approaching flood and how you responded at the time.

55. What actions, if any, did you take to safeguard your property immediately prior to

flooding and what were the damages prevented by each action?

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

Damage Preventive Action (CIRCLE ALL THAT APPLY)	$ Damage Prevented	Hours Spent on Damage Prevention	Cost of Materials for Prevention
1. Moved contents to higher ground	$___________	________ HOURS	$___________
2. Elevated contents to a higher spot in the building	$___________	________ HOURS	$___________
3. Turn off electrical equipment	$___________	________ HOURS	$___________
4. Sandbagged the outside of the building	$___________	________ HOURS	$___________
5. Used another type of temporary barrier	$___________	________ HOURS	$___________
6. Moved vehicles to higher ground	$___________	________ HOURS	$___________
7. Other action _______________________	$___________	________ HOURS	$___________
8. None

ROADWAY DAMAGE

The purpose of this survey is to gain information from area transportation agencies on economic losses due to roadway flooding. These estimates will be used by the Corps of Engineers in economic evaluations. Please provide any information based on damage that occurred (DATE). Note: some questions ask for total cost or number of 8-hour man-days, while others ask for material and labor. Thank you for your participation.

1. How many miles of roadway damage did your jurisdiction experience during the (DATE) flood?

________________ MILES

2. Please estimated cost of roadway repairs following the (DATE) flood:

2a. Cost to repair erosion to roadway embankment:

$____________

2b. Cost to repair roadway pavement:

$____________

2c. Cost to repair roadway shoulder:

$____________

3. Please estimate the costs to monitor roadways for flooding/safety impacts and alert public and agencies affected by an event: $________ or ________man-days

4. Please estimate the costs associated with installation and removal of detour signs and road barricades for the flood roadways in your jurisdiction: $________ or ________man-days.

5. Please estimate the costs of flood protection and other operations provided during the (DATE) flood:

5a. Sandbagging $ __________ and ________ man-days (includes installation, operation, removal and disposal)

5b. pumping materials $_________ and ________ man-days of

6. Please estimated costs of post-flood roadway clean-up the (DATE) flood:

6a. street and gutter sweeping: $________ or ________man-days

6b. cleaning of drainage structures $______total or ________ man days.

7. Please estimate the costs of additional maintenance activities for scour of critical bridges and culverts following the (DATE) flood:

7a. inspection costs: $_________total or ______ man days (per structure)

7b. scour protection measures $ _______ of materials and ______ man days

7c. debris removal on piers/abutments: $________ of materials and _______man-days (per structure)

AGRICULTURAL FLOOD DAMAGE 3