Rapid ATC 20 C.01.08.b Evaluation Safety Assessment Form

ATC-20 Rapid Evaluation Safety Assessment Form

© Copyright 1995-07, Applied Technology Council.

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Technology Council name shall not be used in any advertising or publicity of Licensee product. Permission is further subject to the following conditions: (1) Licensee does not reprint, repackage

or offer this form for sale or license; and (2) no material gain or financial profit is to be made from any sale or license of this form. Placards may be used without restrictions for their intended use

as building postings. All rights not specifically granted to Licensee are herein reserved by ATC.

Inspector ID:

Estimated Building Damage

Areas inspected: Exterior only

Barricades needed in the following areas:

Detailed Evaluation recommended: Structural Geotechnical Other:

Exterior and interior

Observed Conditions: SevereModerate

Collapse, partial collapse, or building off foundation

Building or story leaning

Racking damage to walls, other structural damage

Chimney, parapet, or other falling hazard

Ground slope movement or cracking

Inspection date and time:

Choose a posting based on the evaluation and team judgment. Severe conditions endangering the overall building are grounds for

an Unsafe posting. Localized Severe and overall Moderate conditions may allow a Restricted Use posting. Post INSPECTED

placard at main entrance. Post RESTRICTED USE and UNSAFE placards at all entrances.

Building Description Type of Construction

Address:

Building contact/phone:

Approx. “Footprint area” (square feet):

Number of residential units:

Number of stories above ground: below ground:

Number of residential units not habitable: