1. Parcel Address *

2. Name of the Structure *

3. Name of entity/organization that owns this parcel. *

4. Representative from organization/entity participating in this assessment. *

5. Select all that apply to the person that requested the survey:

6. What is the acreage of the parcel? *

7. How many structures are included in the parcel? *

8. Which building(s) are being covered in this assessment? *

9. Is this parcel included in any local plans (i.e. hazard mitigation, emergency response plans)? *

10. Select the roofing material(s). *

11. Is the roofing material Class A? *

12. If the roof is a mixture of Class A, B and C, provide an estimated percentage for each class.

13. Upload photos of the roof. *

14. Is there a skylight? *

15. Does the skylight feature: (Select all that apply)

16. Are the roof and gutters clear of debris? *

17. Select the gutter material: *

18. Are the gutters covered with metal mesh vents that are at least a 1/16th an inch? *

19. Upload photos of the gutters. *

20. Select the eaves and soffit material: *

21. Are the soffits open or closed? *

22. Are the soffit and eave vents covered with metal mesh vents that are at least 1/16th an inch? *

23. Upload photos of the soffits and eaves. *

24. Is there a pergola attached to the roof? *

25. If so, please select the material:

26. Is there a solid-covered structure attached to the main structure (i.e. garage, shop, separate building, etc). *

27. If so, select the roofing material:

28. General notes & observations *

29. Recommendations *

30. Upload any other photos related to this section.

31. Select the siding material: *

32. If there are multiple types of siding, provide an estimated percentage for each type.

33. Is the material between the exterior wall and the ground base: (Select all that apply) *

34. Upload photos of the siding and base materials. *

35. Select the vents present: *

36. With the EXCEPTION of the dryer vents, are the remaining vents cover with metal mesh that is at least 1/16th of an inch thick? *

37. If applicable, select the siding material for an attached structure:

38. If shutters are present, select the material they are made of:

39. Upload photos of the windows. *

40. If applicable: Are all underfloor areas and projections enclosed or covered with noncombustible material?

41. General Notes & Observations *

42. Recommendations *

43. Upload any other photos related to this section.

44. If there is an attached deck or patio, select all of the building materials for design (including support, flooring, hand rails, stairs, etc.)

45. If a trex deck, select the class rating (if known):

46. Select all that apply to the patio or deck space:

47. Is there an overhang separate from the roof? *

48. If so, select the material:

49. If applicable, select all that apply to the space between the deck floor and the ground base:

50. If so, is it free of debris and/or combustible vegetation that is overgrown?

51. Is there metal mesh between the floor of the deck and the ground base?

52. Upload photos of the deck/patio area.

53. Do the exterior doors include: (select all that apply) *

54. General Notes & Observations *

55. Recommendations *

56. Upload any other photos related to this section.

57. Select the following that apply to the first 5 ft. of the structure/home: *

58. What type of vegetation can be found within the first 5 ft. of the structure/home: (Select all that apply) *

59. If trees are present, has the understory been limbed and pruned to a minimum of 6 ft. for trees over 24 ft., or 1/3rd of the tree's height?

60. General Notes & Observations *

61. Recommendations *

62. Upload photos of the first 5 ft. *

63. Select the following that apply to the first 5-30 ft. of the structure/home: *

64. What type of vegetation can be found within the first 5 ft. of the structure/home: (Select all that apply) *

65. If trees are present, has the understory been limbed and pruned to a minimum of 6 ft. for trees over 24 ft., or 1/3rd of the tree's height?

66. General Notes & Observations *

67. Recommendations *

68. Upload photos of the first 5-30 ft. *

69. Select the following that apply to the first 30+ ft. of the structure/home: *

70. What type of vegetation is within the first 30 ft.+ of the structure? (Select all that apply) *

71. If trees are present, has the understory been limbed and pruned to a minimum of 6 ft. for trees over 24 ft., or 1/3rd of the tree's height?

72. General Notes & Observations *

73. Recommendations *

74. Upload photos of the first 30 + ft. *

75. Was the structure constructed with ignition-resistant roof and siding materials? *

76. Do the windows have double-pane glass?

77. What is the maximum occupancy for the structure being considered? *

78. What is the average height of trees in groups or clusters surrounding the structure being considered? *

79. Demonstrate the math used to calculate the boundaries for mitigation efforts surrounding the structure being considered.

Refer to pages 99-102 of the NIST ESCAPE Report.

80. Does the parcel include the minimum distance required to mitigate the fuel load, based on the formula completed in question 80? For example, if the structure requires an area that extends 300 ft. from the structure, does the parcel include the 300 ft radius?

81. Is the TFRA located centrally, and is it accessible by surrounding residential neighborhoods?

82. What structural modifications will need to be made for this structure to be considered a TFRA?

83. What fuels mitigation activities and/or modifications will need to be made for this parcel to be considered a TFRA? *

84. Upload photos of the TFRA. *