Disaster Damage Assessment
(Infrastructure Damage – Public Property)
COUNTY: ____________________________ MUNICIPALITY________________________________ NAME: ______________________________LONGITUDE____________ LATITUDE:_____________ STREET ADDRESS (Location): __________________________________________________________ CITY: _____________________________, PA, ZIP ________, MUNICIPAL CODE: ______________
Bridge/Culvert Public Building
Fire/EMS Facility Road
Hospital Sanitary Sewer
Nursing Home School
Park/Recreational Area Sewer Treatment
Utility (Type) Storm Sewer
Telephone Water Control Facility
Electric Water Supply
Gas Water Treatment
Sewer Other ____________
Damage Category Estimated Repair Cost
(Check one box only)
Not Functional, Not Repairable (Destroyed)
Not Functional, But Repairable (Major Damage) $ __________________ Functional with Light Damage (Minor Damage)
Describe the damage:
Describe adverse impact on essential facilities and services:
Name of Assessor: __________________________________ Date: ______________
Name Field: In the name field, the corresponding company name and/or owner of the infrastructure damage, the owner of the business or residence should be entered. If the residence is occupied by a business, renter, or leaser please annotate that information in the name field and then enter the owner’s information in the “describe impact on citizens or business field.
Location Field: The location field is one of the most important fields that is on the detail form and is the sole source for ensuring the property or structure is correctly accounted for. This field should be filled with the exact street address if one can be obtained. If an address can not be obtained the reporting individual should use all means to annotate as much information as possible so the property or structure can later been identified. This can be accomplished by several means; some examples are to obtain a street intersection, or know distance from a street/route intersection, a known mile marker, or even a known land mark.
Describe the Damage Field: In the describe the damage field a general synopsis of all damages should be given, to include as much relative information to the property as possible. This could include the loss of a bridge, public buildings damaged, roadway washed out, or even underground utility pipes that have been damaged.
Describe adverse impacts on essential facilities or services field: This field should
capture any additional information that has not previously been received in one of the other fields. Some examples of information to be entered into this field is if emergency equipment could no longer gain access into a location due to a roadway or bridge being destroyed or if municipal owned buildings are damaged to include schools, libraries, utility garages, court houses, etc. If traffic must be diverted to another street or route, then the alternate route should be provided.
Damage Categories - Definitions
Functional with Light Damage: The infrastructure item can still be used for its
intended purpose, however, some minor repairs must be accomplished to restore it to full service or original use.
Not Functional, But Repairable: This category would be used when the infrastructure
item cannot be used at this time but will be usable within a short period of time (days) after restoration or repair to its original condition.
Not Functional, Not Repairable: Use of this category would indicate that the
infrastructure item cannot be used and will require extensive repair (months) or replacement prior to future use.