Water Damage and Mold Growth Condition Incident Report Copy

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General information

• Site location
  Address

• Suspected incident areas.

  Select Above ground level rooms Basement Landscaping Exterior walls Roof

  • Above ground level rooms
  • Basement
  • Landscaping
  • Exterior walls
  • Roof

• Name of person or persons reporting event.

Site findings

• Additional description of effected areas.

• Photos of effected area.

  Media

• Describe what was found?

• Suspected cause of water damage and/ or mold growth.

• Are building materials still wet? If yes, where and to what extent.

  Yes

  No

  N/A

• Is grey or black water present?

  Yes

  No

  N/A

• Is standing water present? If yes, how much.

  Yes

  No

  N/A

• Estimated surface area of the building materials wetted or having mold growth present in Square Feet?

• Date water/mold was discovered?

  Date

• Have any corrective actions been taken to this point?

  Yes

  No

  N/A

Action plan

• Planned actions, If any, at this point?

• Recommended PPE

• Additional comments/ observations?

• Report completed by:

  Sign