BARS-UP STRUCTURAL AUDIT SURVEY FORM

I. General Information:
College/Campus:
ROMBLON STATE UNIVERSITY-MAIN CAMPUS
A. BUILDING INFORMATION:
Building Name: OFFICE OF THE AUDITOR
Address: LIWAYWAY, ODIONGAN, ROMBLON
(Photo of the Building) Number of Floors: 2
Perspective Number of Rooms: 4
Years of the Building: _________________________

B. PRIMARY OCCUPANCY/USES OF THE BUILDING: F. CONSTRUCTION DATA:

Administration Offices Year Built: ______________
☐ Classroom
☐ Commercial G. BUILDING STRUCTURAL COMPONENTS
☐ Faculty Office  Columns
☐ Health Facility ☐ Wood
☐ Residential ☐ Steel
☐ Other Uses __________________________  Reinforced Concrete
 Beams
 No. of Rooms: _________________ ☐ Wood
☐ Steel
C. NUMBER OF OCCUPANTS (PEAK HOURS)  Reinforced Concrete
 0-50
☐ 51-150 Note:  Slab Flooring/ Roof decking
☐ 151-250 (including no. of students) ☐ Wood
☐ 251-350 ☐ Steel
☐ 351+  Reinforced Concrete
 Roof Trusses
D. POTENTIAL NATURAL HAZARDS:  Wood
 Earthquake ☐ Steel
☐ Landslide
 Flood
☐ Tsunami
 Typhoon
☐ Others, Specify: _________________

E. POTENTIAL MAN MADE HAZARDS:

 Electrical Hazards
 Fire Hazards
☐ Near Construction Sites
☐ Near Dikes, Dumpsites etc.
☐ Other Specify (e.g., settlement)
____________________________
II – BUILDING VISUAL INSPECTION:
CONDITION OF STRUCTURAL COMPONENT
Item
Floor No. Wood Frame Steel Frame Reinforced Concrete Remarks
(Description)
☐ Leaning ☐ Leaning ☐ Leaning HAIRLINE CRACKS
☐ Buckled/ Splitting. ☐ Buckled/ Splitting. ☐ Buckled/
☐ Decayed ☐ Corroded Fractured.
☐ Missing/ Loose/ ☐ Missing/  Cracks
Corroded Bolt Loose/Corroded Bolt ☐ Spalling
Connections Connections ☐ Honeycombs
Column
☐ Termite Infestation/ ☐ Tearing ☐ Vulnerable to Short
Damage ☐ Vulnerable to Short Column
☐ Separation from Column
Concrete Pedestal
☐ Vulnerable to Short
Column
☐ Sagging/Deflection ☐ Sagging/Deflection ☐ Sagging/Deflection HAIRLINE CRACKS
☐ Splitting ☐ Corrosion  Cracks
☐ Decayed ☐ Tearing ☐ Spalling
Beams ☐ Missing/ Loose/ ☐ Missing/ Loose/ ☐ Honeycombs
Corroded Bolt Corroded Bolt
Connections Connection
Ground ☐ Termite Infestation
Floor ☐ Sagging/Deflection ☐ Sagging/Deflection ☐ Sagging/Deflection GOOD CONDITION
Slab Flooring/ ☐ Splitting ☐ Corrosion ☐ Cracks
Roof Deck: ☐ Decayed ☐ Deterioration of ☐ Spalling
☐ Termite Infestation Connection to Frame ☐ Leaks
☐ Leaks ☐ Leaks
☐ Buckled Members ☐ Buckled Members N/A
☐ Decayed Member ☐ Corrosion of
☐ Missing/ Loose/ Members
Roof Trusses Corroded Bolt ☐ Missing/ Loose/
Connections Corroded Bolt
☐ Termite Infestation Connections
☐ Tearing
☐ Sagging ☐ Sagging ☐ Sagging NEED TILES
☐ Decayed ☐ Corrosion of ☐ Separation from REPLACEMENT

Stairs
☐ Displacement of Members Joints
Steps/Railing ☐ Displacement of ☐ Spalling
☐ Termite Infestation Steps/Railing  Cracks on Steps
and Rise

CONDITION OF NON-STRUCTURAL COMPONENTS

Item
Floor No. Material Observation Remarks
(Description)
Ground ☐ Concrete Finish  Cracks NEED REPLACEMENT
Floor ☐ Wood ☐ Displacement
Floor Finish  Tiles ☐ Separation of mortar joints
☐ Others _______ ☐ Termite Infestation

 Plywood ☐ Termite Infestation NEED AN IMMEDIATE

☐ Gypsum Board ☐ Materials not securely fastened. REAPIR
Ceiling ☐ Cork Board  Leak marks
☐ Others _______ ☐ warping

Walls Exterior:  Cracks HAIRLINE CRACKS

 4” CHB ☐ Plaster separation (Kapak)
☐ 6” CHB ☐ Paint deterioration
☐ Dry Wall ☐ Termite attack
☐ Reinforced ☐ Others ____________________
Concrete __________________________

Interior:  Cracks HAIRLINE CRACKS

 4” CHB ☐ Plaster separation (Kapak)
☐ 6” CHB ☐ Paint deterioration
☐ Dry Wall ☐ Termite attack
☐ Reinforced ☐ Others ____________________
 Concrete __________________________

Doors ☐ Termite Infestation/Damage GOOD CONDITION

☐ Panel Door ☐ Not securely fastened.
 Glass Door ☐ Out of plumb and cannot be closed/ opened.
☐ Metal Door ☐ Cracked or broken.
☐ Doorknob and locks are broken.
☐ Others ____________________
Doors and
Windows
Windows ☐ Termite Infestation/Damage CR WINDOWS NEED FOR
☐ Wood ☐ Not securely fastened. IMMEDIATE REPAIR
 Glass ☐ Out of plumb and cannot be closed/ opened.
☐ Others  Cracked or broken.
______________ ☐ Locks are broken.
☐ Others ____________________
__________________________

☐ Metal/ GI Sheet ☐ Materials not securely fastened. NEED FOR IMMEDIATE

 Concrete Slab ☐ Deterioration/ Corrosion REPAIR
☐ Discoloration of slab soffit.
Roofing
 Leaking
☐ Others ____________________________

CONDITION OF ANCILLARY/ AUXILLARY EQUIPMENT AND FACILITIES

Item
Floor No. Observation
(Description)
Tank Tank Support System Bracing Pipes
☐ Corrosion ☐ Corrosion ☐ Corrosion ☐ Corrosion
☐ Leakage ☐ Cracks ☐ Not securely  Leakage
Water Supply ☐ Spalling ☐ Spalling fastened to support ☐ Clogging
and Piping ☐ Leaning ☐ Deflection system.  Disconnected/ broken.
Ground system ☐ Not securely ☐ Not securely ☐ Not securely fastened to
Floor fastened to Support fastened to floor/ support system.
System. base.

NEED AN IMMEDIATE
Remarks: ACTION

CONDITION OF STRUCTURAL COMPONENT

Item
Floor No. Wood Frame Steel Frame Reinforced Concrete Remarks
(Description)
Second ☐ Leaning ☐ Leaning ☐ Leaning HAIRLINE CRACKS
Floor ☐ Buckled/ Splitting. ☐ Buckled/ Splitting. ☐ Buckled/
☐ Decayed ☐ Corroded Fractured.
☐ Missing/ Loose/ ☐ Missing/  Cracks
Corroded Bolt Loose/Corroded Bolt ☐ Spalling
Connections Connections ☐ Honeycombs
Column
☐ Termite Infestation/ ☐ Tearing ☐ Vulnerable to Short
Damage ☐ Vulnerable to Short Column
☐ Separation from Column
Concrete Pedestal
☐ Vulnerable to Short
Column
☐ Sagging/Deflection ☐ Sagging/Deflection ☐ Sagging/Deflection HAIRLINE CRACKS
☐ Splitting ☐ Corrosion  Cracks
☐ Decayed ☐ Tearing ☐ Spalling
Beams ☐ Missing/ Loose/ ☐ Missing/ Loose/ ☐ Honeycombs
Corroded Bolt Corroded Bolt
Connections Connection
☐ Termite Infestation
☐ Sagging/Deflection ☐ Sagging/Deflection ☐ Sagging/Deflection
Slab Flooring/ ☐ Splitting ☐ Corrosion  Cracks
Roof Deck: ☐ Decayed ☐ Deterioration of ☐ Spalling
☐ Termite Infestation Connection to Frame ☐ Leaks
☐ Leaks ☐ Leaks
Roof Trusses ☐ Buckled Members ☐ Buckled Members GOOD CONDITION
 ☐ Decayed Member ☐ Corrosion of
☐ Missing/ Loose/ Members
Corroded Bolt ☐ Missing/ Loose/
Connections Corroded Bolt
☐ Termite Infestation Connections
☐ Tearing
☐ Sagging ☐ Sagging ☐ Sagging NEED TILES
☐ Decayed ☐ Corrosion of ☐ Separation from REPLACEMENT

Stairs
☐ Displacement of Members Joints
Steps/Railing ☐ Displacement of ☐ Spalling
☐ Termite Infestation Steps/Railing  Cracks on Steps
and Rise

CONDITION OF NON-STRUCTURAL COMPONENTS

Item
Floor No. Material Observation Remarks
(Description)
☐ Concrete Finish  Cracks NEED TILES
☐ Wood ☐ Displacement REPLACEMENT
Floor Finish  Tiles ☐ Separation of mortar joints
☐ Others _______ ☐ Termite Infestation

 Plywood ☐ Termite Infestation NEED AN IMMEDIATE

☐ Gypsum Board ☐ Materials not securely fastened. REPLACEMENT
Ceiling ☐ Cork Board  Leak marks
☐ Others _______ ☐ warping

Exterior:  Cracks NEED TO REPAINT

 4” CHB ☐ Plaster separation (Kapak)
☐ 6” CHB  Paint deterioration HAIRLINE CRACKS
☐ Dry Wall ☐ Termite attack
☐ Reinforced ☐ Others ____________________
Concrete __________________________

Walls
Interior:  Cracks NEED TO REPAINT
 4” CHB ☐ Plaster separation (Kapak)
☐ 6” CHB  Paint deterioration HAIRLINE CRACKS
☐ Dry Wall ☐ Termite attack
Second ☐ Reinforced ☐ Others ____________________
Floor Concrete __________________________

Doors ☐ Termite Infestation/Damage GOOD CONDITION

☐ Panel Door ☐ Not securely fastened.
 Glass Door ☐ Out of plumb and cannot be closed/ opened.
☐ Metal Door ☐ Cracked or broken.
☐ Doorknob and locks are broken.
Doors and
☐ Others ____________________
Windows
Windows ☐ Termite Infestation/Damage GOOD CONDITION
☐ Wood ☐ Not securely fastened.
 Glass ☐ Out of plumb and cannot be closed/ opened.
☐ Others ☐ Cracked or broken.
______________ ☐ Locks are broken.
☐ Others ____________________
__________________________

 Metal/ GI Sheet ☐ Materials not securely fastened. NEED IMMEDIATE REPAIR

☐ Concrete Slab ☐ Deterioration/ Corrosion
☐ Discoloration of slab soffit.
Roofing
 Leaking
☐ Others ____________________________

CONDITION OF ANCILLARY/ AUXILLARY EQUIPMENT AND FACILITIES

Item
Floor No. Observation
(Description)
Second Water Supply Tank Tank Support System Bracing Pipes
Floor and Piping ☐ Corrosion ☐ Corrosion ☐ Corrosion ☐ Corrosion
 ☐ Leakage ☐ Cracks ☐ Not securely ☐ Leakage
☐ Spalling ☐ Spalling fastened to support ☐ Clogging
☐ Leaning ☐ Deflection system.  Disconnected/ broken.
system ☐ Not securely ☐ Not securely ☐ Not securely fastened to
fastened to Support fastened to floor/ support system.
System. base.

NEED AN IMMEDIATE
Remarks: REPAIR

III. SUMMARY OF ALL PHYSICAL CONDITION

Rating (5 – Very Good, 4 – Good, 3 – Fair, 2- Bad, 1 – Very Bad)
Floor No. Item (Description)
5 – Very Good 4 - Good 3 – Fair 2 – Bad 1 – Very Bad
CONDITION OF STRUCTURAL COMPONENT
Column ☐ ☐ ☐ ☐ ☐
Beams ☐ ☐ ☐ ☐ ☐
Slab Flooring/ Roof ☐ ☐ ☐ ☐ ☐
Deck
Roof Trusses ☐ ☐ ☐ ☐ ☐
Stairs ☐ ☐ ☐ ☐ ☐
CONDITION OF NON-STRUCTURAL COMPONENTS
Floor Finish ☐ ☐ ☐ ☐ ☐
Ceiling ☐ ☐ ☐ ☐ ☐
Ground Floor
Walls ☐ ☐ ☐ ☐ ☐
Doors and Windows ☐ ☐ ☐ ☐ ☐
Roofing ☐ ☐ ☐ ☐ ☐
CONDITION OF ANCILLARY/ AUXILLARY EQUIPMENT AND FACILITIES
Water Supply and Piping ☐ ☐ ☐ ☐ ☐
system
Fire Safety Devices ☐ ☐ ☐ ☐ ☐
Communication and ☐ ☐ ☐ ☐ ☐
Internet Services
Emergency Exit ☐ ☐ ☐ ☐ ☐

Comments: ___________________________________________________________________________________
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III. SUMMARY OF ALL PHYSICAL CONDITION

Rating (5 – Very Good, 4 – Good, 3 – Fair, 2- Bad, 1 – Very Bad)
Floor No. Item (Description)
5 – Very Good 4 - Good 3 – Fair 2 – Bad 1 – Very Bad
Second Floor CONDITION OF STRUCTURAL COMPONENT
Column ☐ ☐ ☐ ☐ ☐
Beams ☐ ☐ ☐ ☐ ☐
Slab Flooring/ Roof ☐ ☐ ☐ ☐ ☐
Deck
Roof Trusses ☐ ☐ ☐ ☐ ☐
Stairs ☐ ☐ ☐ ☐ ☐
CONDITION OF NON-STRUCTURAL COMPONENTS
Floor Finish ☐ ☐ ☐ ☐ ☐
Ceiling ☐ ☐ ☐ ☐ ☐
Walls ☐ ☐ ☐ ☐ ☐
Doors and Windows ☐ ☐ ☐ ☐ ☐
Roofing ☐ ☐ ☐ ☐ ☐
CONDITION OF ANCILLARY/ AUXILLARY EQUIPMENT AND FACILITIES
Water Supply and Piping ☐ ☐ ☐ ☐ ☐
system
Fire Safety Devices ☐ ☐ ☐ ☐ ☐
 Communication and ☐ ☐ ☐ ☐ ☐
Internet Services
Emergency Exit ☐ ☐ ☐ ☐ ☐

Comments: ___________________________________________________________________________________
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IV – ANNEXES AND ATTACHMENTS/ DOCUMENTATION

Attached photos as a proof and documentation of the inspection

V – COMMENTS AND RECOMMENDATIONS:

1. STRUCTURAL COMPONENTS:
☐ Conduct thorough structural investigation
☐ Non-Destructive test must be conducted by inspectorate, competent structural or Civil Engineer.
☐ No need to conduct non-destructive testing but conduct repairs on minor defects
Specify areas to repair and actions for repair : _________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
2. NON-STRUCTURAL COMPONENTS OR ANCILLARY/ AUXILLARY EQUIPMENT AND FACILITIES
☐ Immediate actions on identified components with defect and missing.
Additional Comments: ___________________________________________________________________________
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