Developed by the Public Health Workgroup of the Earthquake Engineering Research Institute’s (EERI) Learning from Earthquake (LFE) Program, this tool is intended to be used in the days and weeks following an earthquake or other disaster to conduct virtual and/or field reconnaissance and to collect information about community-level impacts on social determinants of health (SDOH). Collection of standardized data across earthquake events can promote cross-context comparisons and foster concerted learning and research. Because observations are often collected in a nonlinear, disjointed fashion from a variety of sources, the use of this tool to consolidate collected information can result in a more consistent summary of the event(s). This tool is not designed to be comprehensive, but rather to facilitate identification of common disaster impacts, future areas of research, and to encourage targeted follow-up investigations. Notably, this tool is designed for virtual or field reconnaissance to assess impacts broadly, and is intended to inform the development of - not answer - targeted follow-on research questions. This tool can be utilized by field crews, students, or other responders and researchers. Although this tool focuses on earthquakes, it can also be adapted to other disaster events. This is a draft version that had not yet been pilot/field tested in a real world event at the time of publication. A version 2.0 that integrates lessons learned from pilot/field testing is anticipated. Contributors: Fred Turner, Structural Engineer (SE); Anne Wein, United States Geological Survey (USGS); Jessica Austin, Natural Hazards Center, University of Colorado Boulder; Alexa Hansen, MPH.