Vacant/Abandoned Building Evaluation Form

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Date:
/
/
Building Marking
Vacant/Abandoned Building Evaluation Form
Address: ________________________________________________________________________________________
Property Name: __________________________________________________________________________________
Owner Name: ____________________________________ Telephone: ____________________________________
Owner Address: _________________________________________________________________________________
Answer each of the following questions about the building. Select multiple options, if necessary; explain response.
Draw a simple sketch of the location and explain your observations in a brief narrative.
Building Security
Secure
Open/unsecured
Signs of recent entry
Utilities
(Note Entry Points for each active utility on sketch)
Active Utilities
No
Yes If Yes:
Gas
Electricity
Oil
Water
Building Use
(The original use of the building and how it was last used)
Building Construction
Number of Floors
Basement:
Yes
Sub-Basement
Multi Sub-Levels
Exterior Walls
Block/Brick
Curtain Wall
Wood
Metal Tie Rods
(stars)
Openings in Exterior Walls
Many
Few
Windowless
(Windows, Doors, etc.)
Structural Members
Steel
Concrete
Wood
Mixed
(Describe)
(Beams, Girders, Columns)
Truss Construction
Roof
Floors
Exposed Structural Members
Yes
No
(Beams, Girders, Columns & Trusses)
Ceiling Type
None
Suspended
Metal
Sheetrock/Plaster
Wood
Condition of Interior Walls and Floors
(Integrity of compartmentation)
Multiple penetrations that
Walls
Good
Deteriorating
would allow fire spread
Floors
Condition of Roof
Good
Some instability/deterioration
Major deterioration
General Condition of Structure
Good
Minor structural instability
:
Major deterioration of structural elements
Fire Protection Systems
Operational Fire Alarm System
Yes
No
System off, but usable if
System
Operational Sprinkler
Yes
No
supplied through FD connection
(Valves open, pressure showing on gauges)
Operational Standpipe System
Yes
No
Fire Department Connection
Yes
No
(If Yes, note location on sketch)
Date:
/
/
Building Marking
Vacant/Abandoned Building Evaluation Form
Address: ________________________________________________________________________________________
Property Name: __________________________________________________________________________________
Owner Name: ____________________________________ Telephone: ____________________________________
Owner Address: _________________________________________________________________________________
Answer each of the following questions about the building. Select multiple options, if necessary; explain response.
Draw a simple sketch of the location and explain your observations in a brief narrative.
Building Security
Secure
Open/unsecured
Signs of recent entry
Utilities
(Note Entry Points for each active utility on sketch)
Active Utilities
No
Yes If Yes:
Gas
Electricity
Oil
Water
Building Use
(The original use of the building and how it was last used)
Building Construction
Number of Floors
Basement:
Yes
Sub-Basement
Multi Sub-Levels
Exterior Walls
Block/Brick
Curtain Wall
Wood
Metal Tie Rods
(stars)
Openings in Exterior Walls
Many
Few
Windowless
(Windows, Doors, etc.)
Structural Members
Steel
Concrete
Wood
Mixed
(Describe)
(Beams, Girders, Columns)
Truss Construction
Roof
Floors
Exposed Structural Members
Yes
No
(Beams, Girders, Columns & Trusses)
Ceiling Type
None
Suspended
Metal
Sheetrock/Plaster
Wood
Condition of Interior Walls and Floors
(Integrity of compartmentation)
Multiple penetrations that
Walls
Good
Deteriorating
would allow fire spread
Floors
Condition of Roof
Good
Some instability/deterioration
Major deterioration
General Condition of Structure
Good
Minor structural instability
:
Major deterioration of structural elements
Fire Protection Systems
Operational Fire Alarm System
Yes
No
System off, but usable if
System
Operational Sprinkler
Yes
No
supplied through FD connection
(Valves open, pressure showing on gauges)
Operational Standpipe System
Yes
No
Fire Department Connection
Yes
No
(If Yes, note location on sketch)
Fire Potential
Fuel Packages
(Fuel Load)
Numerous
Moderate
Limited
Quantity
Concentrated
Spread out
Distribution
Housekeeping
Good
Poor
Interior Finish
Combustible
Non-combustible
Mixed
(Describe)
Room Size
Large
Moderate
Small
Potential for a delay in FD notification
High
Medium
Low
Exposures
(Note locations on sketch)
Location
A side
B side
C side
D side
Separation
(ft)
Occupied
(Y/N)
Suppression Operations
Hazards In Building
Holes in Floors
Missing Stairs
Open Shafts/pits
Building Access:
4 sides
3 sides
2 Sides
Limited
Interior Layout
Complicated
Normal - Walls/Partitions
Open
Water Supply:
Adequate
Inadequate
(Note Locations on Sketch)
Hazardous materials located on the site
Yes
None Observed
(If Yes, describe in detail)
Conditions that require immediate correction
Yes
No
(If Yes, describe in detail)
Analysis of the building
High
Moderate
Low
(provide your analysis of the building)
Potential for an exposure fire (extension to another building)
Potential for a Multi-Room fire on arrival of first due company
Potential for structural collapse early in the fire development
Potential for fire fighters to become lost or trapped during operations
Narrative
:
Inspected by:
Posting Authorized by:
Data Entered by:
IAAI/USFA Rev 13.3

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