Call:
424 388 1960
SCHEDULE AN ASSESSMENT
Product Info
Schedule an
Assessment
Defend your home from wildfires.
FDS Assessment Form - PRIMARY
SCHEDULE AN ASSESSMENT
Homeowner FIRST NAME
*
Homeowner LAST NAME
*
STREET ADDRESS to be assessed
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip code
Homeowner Email Address
*
Primary phone number
Pool capacity
Under 10,000 Gallons
Under 20,000 Gallons
Under 30,000 Gallons
More than 30,000 Gallons
I don't know
I don't have a pool
Preferred Day(s) of the week for Assessment
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
No preference
PLEASE CHECK ALL THAT APPLY
Preferred Time of Day for Assessment
Morning
Afternoon
Evening
No preference
PLEASE CHECK ALL THAT APPLY
Anything else you'd like us to know?
1) CONTACT NAMES
DO NOT LIST THE PRIMARY HOMEOWNER ALREADY ENTERED ABOVE
Emergency Contact Title/Relationship
Owner
Spouse
Relative
Occupant/Resident
Nearby neighbor
Friend
Other
Other
Emergency Contact 2 Title/Relationship
Owner
Spouse
Relative
Occupant/Resident
Nearby neighbor
Friend
Other
Other
Is your property regularly landscaped and maintained?
Yes
No
2) NEAREST FIRE STATIONS
3) GENERAL ASSESSMENT INFO
FDS Assessor Name
Jimmy Prabhu
Danny Cortazzo
John Prabhu
Michael Prabhu
Other
Other
Date of site assessment
Was the homeowner present during the site assessment?
Present
Not Present
Others present during site assessment
Name 1
Name 1
Name 2
Name 2
Name 3
Name 3
Name 4
Name 4
All other names...
All other names...
Number of STRUCTURES located on the property
one
two
three
four
five
six or more
Other structures on the property include
guest house
storage shed
garden shed
pool cabana
gym
Other (please specify)
Other (please specify)
PLEASE CHECK ALL THAT APPLY
Total number of PERSONS typically present on the property
None
One
Two
Three
Four
Five
Six or more
Total number of PETS OR LIVESTOCK typically present on property
None
One
Two
Three
Four
Five
Six or more
Types of pets or livestock located on property
dog(s)
cat(s)
fish
bird(s)
horse(s)
Reptile(s)
Other
Other
PLEASE CHECK ALL THAT APPLY
4) MAIN HOUSE DETAIL
How frequently is the MAIN HOUSE occupied?
most of the time. It is a primary residence
6-11 months per year
less than 6 months per year
Other
Other
Home Type & Character Main House
one story single family residence
two story single family residence
three story single family residence
Other
Other
Basement Main House
The home has a basement.
There is no basement in the home.
SIDING MATERIAL Main House
stucco
treated wood siding
untreated wood siding
painted wood siding
Other
Other
ROOFING MATERIAL Main House
solar tiles
asphalt shingles
metal roofing
stone coated steel
slate
rubber slate
clay and concrete tiles
green roof
tar & gravel (BUR)
treated wood shingles
untreated wood shingles
I don't know
Other
Other
Solar panels on the main house?
There are solar panels installed on the roof of the main house.
There are no solar panels installed on the roof of the main house.
Does the main house have an ATTACHED garage?
attached 1 car garage
attached 2 car garage
attached 3 car garage
attached 4 or more car garage
no attached garage
Does the main house have a DETACHED garage?
a detached 1 car garage
a detached 2 car garage
a detached 3 car garage
a detached 4 or more car garage
no detached garage
5) STREET ASSESSMENT
Fire hydrant visibility
clearly visible from the street
not clearly visible from the street due to landscaping. Fire hydrant should have 36” of clearance for easy access
Distance of the nearest fire hydrant from the home
in close proximity to the home (less than 200 feet)
more than 200 feet from the home and requires long hose lays
Location of the nearest fire hydrant
on the same side of the street as the home
on the opposite side of the street, making it undesirable during a wildfire event. Hose lines will cross the street and be vulnerable to damage from traffic, especially in an emergency situation
on a deadend main. The water pressure in such a hydrant is not reliable and is based upon the amount of water being utilized in the system prior to the hydrant location.
Other (please specify)
Other (please specify)
Address numbers and visibility
clearly visible from both directions of travel from the street. Numbers at least 4 inches in height would be easy to see in low visibility conditions
only visible from one direction of travel
not clearly visible due to landscaping. Clear all vegetation that blocks the address from the street in both directions of travel or move the address location to a better position
the numbers are likely difficult to see in an emergency situation due to their small size. FDS recommends a minimum height of 4 inches
Other (please specify)
Other (please specify)
FDS Signage location
FDS sign to be located on the B side of the Driveway
FDS sign to be located on the D Side of the Driveway
Other
Other
Gate accessibility
no access to home.
a mechanical swing gate(s) with manual override. Post instructions on the motor box of the gate on how to manually override the gates. Include any tools required in the event the power goes out. Keep gates open during an wildfire event for emergency personnel access. Securely prop them open to prevent them from being blown closed by high winds.
a mechanical slide gate(s) with manual override. Post instructions on the motor box of the gate on how to manually override the gates. Include any tools required in the event the power goes out. Keep gates open during a wildfire event for emergency personnel access.
a manual gate to access the residence. Keep gates open during a wildfire event for emergency personnel access. Securely prop them open to prevent them from being blown closed by high winds.
key required for manual override of gate.
Other
Other
Driveway accessibility
clear access for fire apparatus. There is adequate clearance and there are no overhead obstructions.
long driveway/narrow access with adequate space near structure for fire apparatus.
restricted access and fire apparatus will most likely park on the street.
Other
Other
6) ROOFING ASSESSMENT
Main house roofing inspection
The roof was clear of debris at the time of inspection.
Accumulated debris was observed on the roof at the time of inspection.
Other
Other
Main house gutters inspection
Gutters appeared clean at the time of inspection. Continue with regular maintenance and be especially vigilant during the Fall and after high wind events when leaves and debris are most likely to blow off trees and onto roofs and into gutters.
Gutters contained accumulated debris at the time of inspection. Clean the gutters and continue with regular maintenance. Be especially vigilant during the Fall and after high wind events when leaves and debris are most likely to blow off trees and onto roofs and into gutters.
Other
Other
7) FIRE DEFENSE SERVICES DEFENSIBILITY ASSESSMENT
Defensible space exists around the main house on
A side
B side
C side
D side
There is no defensible space around the home.
Landscape vegetation makes DIRECT CONTACT with the home
A side
B side
C side
D side
No landscape vegetation was observed to be in contact with the home.
Trees or landscaping comes into CLOSE PROXIMITY with the home or eves
A side
B side
C side
D side
No trees or landscape vegetation was observed to be in close proximity with the home.
Trees or landscaping OVERHANGS THE ROOF
A Side
B Side
C Side
D Side
No trees or landscape vegetation was observed overhanging the roof.
COMBUSTIBLE ITEMS OR FURNITURE were observed.
A Side
B Side
C Side
D Side
There were no combustible items observed near to the home.
TEMPORARY SAFE REFUGE ZONES are located on
A Side
B Side
C Side
D Side
There are no temporary safe refuge zones outside the home.
Vent screen locations MAIN HOUSE
observed on the foundation
observed under the eve
not noted
Vent screen characteristics MAIN HOUSE
adequate and measured less than 1/8 inch mesh opening
inadequate and should be augmented with a mesh that is less than 1/8 inch
an accurate measurement of mesh size was not able to be secured
not present
8) POOL DETAILS
Pool Location
A Side
B Side
C Side
D Side
Pool on property?
on the homeowner's property
on an adjacent property
Location of the deep end of the pool
A Side
B Side
C Side
D Side
FDS recommended equipment storage location
A Side
B Side
C Side
D Side
FDS recommended pump deployment location (Normally at deep end of pool)
A Side
AB Side
B Side
BD Side
C Side
CD Side
D Side
AD Side
Is there a second water source on the property?
No secondary water source
Additional swimming pool
Water tank
Fish pond
Other
Other
9) GENERAL PROPERTY CHARACTERISTICS
Property slope and general characteristics
mild sloping
moderate sloping
steep sloping
no sloping. Property is generally flat
and has a canyon on the A Side
and has a canyon on the B Side
and has a canyon on the C Side
and has a canyon on the D Side
Other
Other
10) GUEST HOUSE DETAIL
How frequently is the GUEST HOUSE occupied?
most of the time. It is a primary residence
6-11 months per year
less than 6 months per year
Other
Other
Home Type & Character GUEST House
one story single family residence
two story single family residence
three story single family residence
Other
Other
Guest House Basement
The guest house has a basement
There is no basement in the guest house
SIDING MATERIAL GUEST House
stucco
treated wood siding
untreated wood siding
painted wood siding
Other
Other
Location of ELECTRICAL PANEL Guest House
A Side
B Side
C Side
D Side
Structure does not have electrical panel
Location of GAS SHUTOFF Guest House
A Side
B Side
C Side
D Side
Structure does not have a gas shutoff.
ROOFING MATERIAL Guest House
solar tiles
asphalt shingles
metal roofing
stone coated steel
slate
rubber slate
clay and concrete tiles
green roof
tar & gravel (BUR)
treated wood shingles
untreated wood shingles
I don't know
Other
Other
Solar panels on the GUEST house?
There are solar panels installed on the roof of the guest house.
There are no solar panels installed on the roof of the guest house.
Vent screen locations GUEST HOUSE
observed on the foundation
observed under the eve
not noted
Vent screen characteristics GUEST HOUSE
adequate and measured less than 1/8 inch mesh opening
inadequate and should be augmented with a mesh that is less than 1/8 inch
an accurate measurement of mesh size was not able to be secured
not present
Does the GUEST house have an ATTACHED garage?
attached 1 car garage
attached 2 car garage
attached 3 car garage
attached 4 or more car garage
no attached garage
Does the GUEST house have a DETACHED garage?
detached 1 car garage
detached 2 car garage
detached 3 car garage
detached 4 or more car garage
no detached garage
11) ADDITIONAL STRUCTURES?
Do you want to add an additional structure?
Yes
No
12) ADDITIONAL STRUCTURE BASICS
Type of additional structure
detached garage of main house
detached garage of guest house
Other major structure
Other major structure
SIDING MATERIAL additional structure
stucco
treated wood siding
untreated wood siding
painted wood siding
Other
Other
ROOFING MATERIAL additional structure
solar tiles
asphalt shingles
metal roofing
stone coated steel
slate
rubber slate
clay and concrete tiles
green roof
tar & gravel (BUR)
treated wood shingles
untreated wood shingles
I don't know
Other
Other
Location of ELECTRICAL PANEL additional structure
A Side
B Side
C Side
D Side
Structure does not have electrical panel
Location of GAS SHUTOFF additional structure
A Side
B Side
C Side
D Side
Structure does not have gas shutoff
Defensible space around additional structure exists on
A Side
B Side
C Side
D Side
There is no defensible space around the home.
Vent screen locations on the additional structure
observed on the foundation
observed under the eve
not noted
Vent screen characteristics on the additional structure
adequate and measured less than 1/8 inch mesh opening
inadequate and should be augmented with a mesh that is less than 1/8 inch
an accurate measurement of mesh size was not able to be secured
not present
13) CONFIGURATION PARTS LIST
100 foot 1-1/2 inch hose
0
1
2
3
4
5
6
7
8
9
10
Other
Other
50 foot 1-1/2 inch hose
0
1
2
3
4
5
6
7
8
9
10
Other
Other
100 foot 1 inch hose
0
1
2
3
4
5
6
7
8
9
10
Other
Other
1-1/2 inch nozzle
0
1
2
3
4
5
6
7
8
9
10
Other
Other
1 inch nozzle
0
1
2
3
4
5
6
7
8
9
10
Other
Other
Gated Wye
0
1
2
3
4
5
6
7
8
9
10
Other
Other
1-1/2 inch to 1 inch reducers
0
1
2
3
4
5
6
7
8
9
10
Other
Other
Hose Layout Diagram
0
1
2
3
Other
Other
Pump Starting directions
0
1
2
3
Other
Other
FDS Sign (with pre-plan)
0
1
2
3
Other
Other
Strobe Light
0
1
2
3
Other
Other
Air horn
0
1
2
3
Other
Other
Flashlight
0
1
2
3
Other
Other
Fire extinguisher
0
1
2
3
Other
Other
Rubber Mallet
0
1
2
3
Other
Other
Hose Layout Diagram
0
1
2
3
Other
Other
Spanner Wrenches
0
1
2
3
Other
Other
14) FINAL COMMENTS
15) IMAGES
If you are human, leave this field blank.
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