OREGON EMERGENCY MANAGEMENT
INFRASTRUCTURE (PUBLIC ASSISTANCE) INITIAL DAMAGE ASSESSMENT FIELD DATA COLLECTION FORM
NAME OF PUBLIC (GOVERNMENT) OR PRIVATE NONPROFIT AGENCY: Haskin County Public Works COUNTY: Haskin
(List damage and emergency response costs for only one agency on each form. Use more than one form per agency if
necessary. Only certain private nonprofits should be included on this form. Additional Instructions for this form on reverse side.)
Category Brief Description of Damage or Cost Location Estimated Cost Comments (Impacts)
Embankment failure 28' x 8 x 8' plugging and destroying 30' x 18" CMP. One Main Creek Road, MP1.3 One lane open to traveling public
lane open for traveling public. Estimate by force account labor.
EXAMPLE 1
C $7,500.00
Lone Oak road, MP4.2 Road is closed - 40 homes in area, alternate route for public
Destroyed Road Prism 200' x 25' x 23' deep, replace destroyed 90' 72" CMP and emergency vehicles is 8 miles.
culvert. Repair to pre-disaster condition estimated using force account labor
C $600,000. EXAMPLE 2 $600,000.00
Devlin Road. Mp 1-1.5 One lane pushed open for access of emergency vechicles
Extensive downed trees: over 70. estimate based upon historical contractor
and dwellings. 23 homes in immediate area. No alternate
rate to remove. Estimate also includes force account labor for clearance of one
routes.
lane for emergency and access to dwellings. EXAMPLE 3
A $40,000.00
Inspector's Name: Joe Smith Contact Information: 555-555-1234 Date: 11/30/11
This Page Total by Category Total
Total A $40,000 Total E $0 $647,500.00
Total B $0 Total F $0
Total C $607,500 Total G $0
Total D $0 Total $647,500
INSTRUCTIONS FOR THE INSTRUCTIONS ( PUBLIC ASSISTANCE ) INITIAL DAMAGE ASSESSMENT FIELD DATA COLLECTION FORM
This form is intended to be utilized by local government officials or their agent during the Initial Damage Assessment (IDA) to record estimates of damage,
costs, and impacts of the disaster on public infrastructure. The following categories of work shall be utilized:
Emergency Work Categories Permanent Work Categories
A = Debris Removal C = Roads and bridges
B = Protective Measures D = Water control facilities
E = Public buildings and equipment
F = Public utility systems
G = Parks and other
List the work performed, and public facilities damaged, as a direct result of the disaster. Estimate the cost of repair or restoration of damaged public
facilities. Be sure to include both work that has been completed and which has not.
For Roads and bridges on the Federal Aid System, Enter "FAS" instead of "C" under the category of work; likewise for debris removal and protective
measures related to FAS facilities. Alternatively, FAS damage and costs can be listed on separate field data collection forms if the local jurisdiction
wishes. Although FAS costs will not be a factor in determining a request for a Presidential declaration, it may be useful to assess and summarize
these damages for inclusion in any requests to the FHWA for assistance.
Only private nonprofits (PNPs) providing the following types of government-like services to the general public should be included on this form: education
facilities, utilities, emergency or medical facilities, custodial care facilities, museums, zoos, community centers, libraries, homeless shelters, and
senior citizen centers. All other PNPs should be treated as businesses fro the purpose of damage assessment, and included on Individual Assistance
damage assessment forms.
Local officials should be prepared to provide state and federal officials with a detailed cost breakdown of personnel, equipment, materials, and supplies
for all completed work. While a variety of forms can be used to summarize these items, the format must document the type and location of work
performed. Sample forms are available in the Disaster Recovery Assistance Guidebook. Be prepared to describe which sites will be repaired or
reconstructed by estimates of potential threats and routine maintenance should not be listed on the forms.
Totals should be summarized on the Initial Damage Assessment Summary Report Form.
Excel Tips: To copy IDA DATA Form, highlight IS IDA DATA tab with cursor arrow + Ctrl, then drag.