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Foundation Damage Level :
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Date and Time of Observation :
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Number of Stories Above Ground :
Number of Stories Below Ground :
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Retrofitted :
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Vertical Load System :
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Energy Dissipation Devices :
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Site Observation :
Estimated Economical Loss (Lifelines & Transportation) :
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Timezone :
Site Owner :
Site Latitude :
Site Longitude :
Functionality :
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Deaths :
Injuries :
Seismic Strengthening Features :
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Estimated Economic Loss :
Additional Notes (Lifelines & Transportation) :
Bridge ID :
Route :
Bridge Foundation :
Length (ft) :
Width (ft) :
Year Built :
Retrofit :
Year of Retrofit :
Causes of Damage (Bridges) :
Bridge Functional :
Estimated Repair Time :
Additional Notes (Bridges) :
Lead Organization :
Level of Lead Organization :
Type of Organization :
Incident Command System Functional Area :
Additional notes (Emergency Management/Response) :
Surface Area Affected (sq. m.) :
Ejecta Material :
Horizontal Displacement (m) :
Vertical Displacement (m) :
Additional Notes (Liquefaction/Lateral Spreading) :
Material Type :
Area Affected (square meters) :
Vulnerable Facilities :
Additional Notes (Ground Deformation - Landslide) :
Offset Feature Type :
Slip Length (meters) :
Fault Movement :
Slip Azimuth (degrees) :
Plunge (degrees) :
Additional Notes (Ground Deformation - Fault Rupture) :
Body of Water :
Wave 1 Time of Arrival (Local Time) :
Wave 1 Height (Meters) :
Wave 2 Time of Arrival (Local Time) :
Wave 2 Height (Meters) :
Wave 3 Time of Arrival (Local Time) :
Wave 3 Height (Meters) :
Were Tsunami Warnings Issued at This Location :
Additional Notes (Tsunami/Seiche) :
Causes of Damage (Other) :
Estimated Economic Loss (Other) :
Additional Notes (Other) :