ESEN
CITIZEN INITIATIVE
Digitized and Coded
Open Source Version
Format Based on
ATC-20 Form
Ministry of People's Power
for Interior Relations, Justice and Peace
Venezuelan Foundation
for Seismological Research (Funvisis)
Instrument for Inspection of Earthquake-Damaged Buildings
1. INSPECTOR DATA
RoleFull NameID / CedulaProfessionPhoneEmail
Inspector
Inspector
Supervisor
2. GENERAL DATA
Name:
Start Time:
Date:
Nº Floors:
Nº Basements:
State:
City:
Municipality:
Urb:
Sector:
Ave, St:
3. BUILDING USE
Governmental
Military
Medical-Care
Industrial
Fire Dept
Social Housing
Educational
Commercial
Civil Protection
Multifamily Residential
Sports-Recreation
Office
4. STRUCTURAL TYPE
REINFORCED CONCRETESTEELMASONRYOTHER
Moment Frames
Shear Walls
Precast
Braced Frames
Unbraced Frames
Connections
Bolted
Welded
Confined
Unconfined
Mixed low-quality frame systems
Precarious construction
Wattle and Daub
Other (Specify):
5. EXTERNAL INSPECTION WITHOUT ACCESSING THE BUILDING
Classificationabc
Structural collapse
None
Partial
Total
Risk to adjacent buildings
None
Moderate
High
Geological hazard
None
Moderate
High
Building settlement
< 0,2 m
0,2 m - 1 m
> 1 m
Building tilt
< 1 cm / 60 cm
1/60 - 2/60
> 2 cm / 60 cm
5.1 EXTERNAL RISK LEVEL
A (all a)
B (b≥1)
C (c≥1)
6. IS INTERNAL INSPECTION REQUIRED?
Yes
No
7. FLOOR PLAN SKETCH (Critical Floor)
CITIZEN INITIATIVE
Digitized and Coded
Venezuelan Foundation for Seismological Research
8. INTERNAL INSPECTION
Structural ElementNumber of Elements in Critical Floor
Double-click to auto-mark (✓)		Total
Elements		Damage Percentage
No damage
(I)		Slight
(II)		Moderate
(III)		Severe
(IV)		Complete
(V)		% with III% with IV% with V
Column
Beam
Wall
Node / connection
Slab
Masonry
9. DAMAGE TO STRUCTURAL ELEMENTS
Damage Percentagesabc
Percentage of damage III
< 30%
30-60%
> 60%
Percentage of damage IV
< 10%
10-30%
> 30%
Percentage of damage V
< 1%
1-10%
> 10%
9.1 STRUCTURE RISK LEVEL
A (all a)
B (b=1 & c=0)
C (b≥2 or c≥1)
10. DAMAGE TO NON-STRUCTURAL ELEMENTS
Elementsabc
Walls / Partitions
No/slight damage
Cracks, separation
Falling hazard
Stairs
No/slight damage
Extended cracks
Falling hazard
Tanks / Balconies
No/slight damage
Visible deformation
Falling hazard
Facade / Ceilings
No/slight damage
Cracks, deformation
Falling hazard
10.1 NON-STRUCTURAL ELEMENTS RISK LEVEL
A (all a or b≤2)
B (b≥3)
C (c≥1)
11. FINAL DECISION
(Take the most unfavorable risk level between points 5.1, 9.1 and 10.1)
ABC
Inspected Building.
Access Permitted
(Green Placard)
Restricted Access.
Caution when Entering
(Yellow Placard)
Unsafe Building.
Access Not Permitted
(Red Placard)
11.1 If there was a previous inspection, what was the placard?
Green
Yellow
Red
12. RECOMMENDATIONS
Specialized inspection
Structure
Geotech
Public Utilities
Intervention by
Civil Prot / Fire Dept
Police - Army
Authorities
13. SECURITY MEASURES
Restrict pedestrian passage
Disconnect water
Shore up / Brace
Restrict vehicle traffic
Disconnect power
Demolish elements
Hazardous materials handling
Disconnect gas
Evacuate adjacent bldg
Indicate locations in the building to apply measures:
14. OBSERVATIONSCompletion Time:
Photos to take: Building Identification - Facades - Terrain slope - Nearby slope - Structural type - Slides or rockfalls - Differential settlement(s) - Facade cracks - Critical floor details: Beams - Columns - Slabs - Joints - Nodes or connections - Observations - Damage to non-structural elements - Buckling and deformations in steel elements - Status of public utilities
Digital Photographic Annex
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