Building Diagnostic Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Building Type

• Levels

  Select Single Story Multiple Story

  • Single Story
  • Multiple Story

• Foot Print

• Construction Materials

  Select Timber Gibb Tongue and Groove Custom Board Chip Board Wall Paper Carpet Lino Other

  • Timber
  • Gibb
  • Tongue and Groove
  • Custom Board
  • Chip Board
  • Wall Paper
  • Carpet
  • Lino
  • Other

• General Condition

  Select As New Renovated Old but Clean Old and un-maintained Well Maintained Poorly Maintained Neglected

  • As New
  • Renovated
  • Old but Clean
  • Old and un-maintained
  • Well Maintained
  • Poorly Maintained
  • Neglected

• Photos

  Media

Effect (mould etc)

• Health effects on occupants

• Effect on building/materials

• Photos

  Media

Environment

• How wet is the Environment?

  Damp

  Dry

  Average

• Are there external environmental issues that would result in dampness or mould?

• Photos

  Media

Causes

• Are there multiple causes?

• Drawing

  Drawing

• Primary factor:

• Secondary factor:

• Tertiary factor:

• Quaternary factor:

• Quinary factor:

Summary

• Comments

• Technician

  Sign