Heritage Building Survey Form
Complete this survey to document the building's heritage context, condition, risks, and recommended preservation actions.
Building Identification
Building Name
*
Site Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Survey Date
*
-
Month
-
Day
Year
Date
Surveyor Name / Role / Organization
*
Heritage Status and Context
Heritage designation / status
*
Please Select
Listed
Registered
Locally significant
In conservation area
Not formally designated
Unknown
Construction period / approximate year built
*
Original / known historic function
Residential
Commercial
Industrial
Religious
Agricultural
Public / civic
Military
Transport
Mixed use
Unknown
Other
Historical significance, alterations, and previous conservation work
Site Access and General Observations
Site access limitations
*
No limitations
Minor limitations
Major limitations
Access not available
Other
Inspection coverage
*
Fully inspected
Partially inspected
External only
Not inspected
Overall comments and summary observations
Condition Assessment
Condition Summary by Building Element
*
Rows
Condition
Urgency
Roof
1
2
Walls
3
4
Foundations
5
6
Floors
7
8
Windows and Doors
9
10
Decorative Features
11
12
Interiors
13
14
Visible Defects – Roof
Cracks
Moisture ingress
Missing materials
Deformation
Corrosion
Rot
Other
Visible Defects – Walls
Cracks
Moisture ingress
Settlement
Missing materials
Deformation
Corrosion
Rot
Other
Visible Defects – Foundations
Cracks
Settlement
Moisture ingress
Deformation
Other
Visible Defects – Floors
Cracks
Settlement
Deformation
Rot
Moisture ingress
Other
Visible Defects – Windows and Doors
Cracks
Rot
Corrosion
Missing materials
Deformation
Moisture ingress
Other
Visible Defects – Decorative Features
Cracks
Missing materials
Deformation
Decay
Corrosion
Other
Visible Defects – Interiors
Cracks
Moisture ingress
Rot
Missing materials
Deformation
Other
Materials, Services, and Risk Factors
Observed building materials
*
Stone
Brick
Timber
Plaster
Metal
Glass
Roof coverings
Other
Condition of observed materials
*
Rows
Good
Fair
Poor
Not observed
Stone
15
16
17
18
Brick
19
20
21
22
Timber
23
24
25
26
Plaster
27
28
29
30
Metal
31
32
33
34
Glass
35
36
37
38
Roof coverings
39
40
41
42
Electrical services condition
Good
Fair
Poor
Not observed
Unknown
Plumbing, heating, and drainage condition
Good
Fair
Poor
Not observed
Unknown
Observed environmental or external risks
Water damage
Vegetation growth
Pollution
Vibration
Fire risk
Vandalism
Pests
Weather exposure
Other
Immediate health and safety hazards observed
Documentation, Recommendations, and Follow-up
Photos and Supporting Documents
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Notes
Recommended Actions
Monitor
Repair
Urgent Stabilization
Detailed Specialist Survey
Conservation Plan
Other
Priority / Timeline
Please Select
Immediate
Within 1 Month
Within 3 Months
Within 6 Months
Within 12 Months
Ongoing Monitoring
Survey Entry Confirmation
Submit Survey
Submit Survey
Should be Empty: