Incident Ground Management Windscreen Damage Assessment Worksheet

• Windscreen Assessment Report
  10 Street block

• Suburb

• Conducted on

  Date

• Prepared by

Allocated Area

• Sector or Appliance if applicable

Street Data

• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses With No Damage

  100%

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 99%

• Houses With Minor Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A

• Houses With Major Damage

  0% - 25%

  26% - 50%

  51% - 75%

  76% - 100%

  N/A
• Street
  Address

• Houses No Damage

  Yes

  No

  N/A

• Houses Minor Damage

  Yes

  No

  N/A

• Houses Major Damage

  Yes

  No

  N/A
• Street
  Address

• Houses No Damage

  Yes

  No

  N/A

• Houses Minor Damage

  Yes

  No

  N/A

• Houses Major Damage

  Yes

  No

  N/A

Tree Damage

• Are there any trees threatening structures?

  Yes

  No

  N/A

• Are there any trees blocking property access?<br>

  Yes

  No

  N/A

Road Damage / Access

• Are Roads Accessable

  Yes

  No

  N/A

• Are there tree over roads?

  Yes

  No

  N/A

General

• Are there any known Dialysis or Diabetic residents in this area?

  Yes

  No

  N/A

• Are there any other general observations or comments

  Yes

  No

  N/A

• Rate the level of damage by percentage

• Select date

  Date

• Add signature

  Sign