DISASTER PLAN WORKBOOK

Use this form as a master; make copies of this form for use. A separate form should be filled out for each floor affected.

This form must be filled out during initial damage assessment by the Disaster Preparedness Committee and _______________. A completed copy of this form must be sent to _______________.

1. Date:
   
2. Floor/Department:
   
3. Type of damage (water, fire, etc):
   
   
   
4. Type of material damaged (books, photographs, etc):
   
   
   
5. Extent of damage (how many volumes, reels, linear feet etc):
   
   
   
6. Environmental conditions (dampness, heat, etc):
   
   
   
7. Condition of surrounding area (wet carpets, wet walls, broken files, etc):
   
   
   
8. Form prepared by:____________________

Use this form as a master; make copies of this form for use. A completed copy of this form must be sent to ____________________.

1. Date of disaster:
2. Floor/Department:
3. Type of disaster:
   • Water (flood/leak)
   • Fire
   • Other - please describe:

4. Source of problem:
   Water:
   • Pipe(s)
   • Drain(s)
   • Sink/Toilet
   • Roof
   • Other:

   Fire:

   • Electrical
   • Waste paper
   • Other:

5. Area(s) affected:
   • East
   • West
   • North
   • South
   • Range(s) affected:

6. Approximate number of items involved:
7. Types of materials affected and amounts of each:
   • Books
   • Microforms
   • Drawings
   • Manuscripts
   • Audiovisual
   • Software
   • Other - please describe:

8. Recovery options used: (List approximate number of items treated by each method below)
   • Air Dry/Interleaving
   • Freeze
   • Replacement
   • Rebind
   • Withdrawn
   • Evidence of mold
   • Other- please specify:

9. Personnel involved:

10. Notes(use reverse if necessary):