Water Damage Restoration Checklist

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Site of water damage
  Address

• Client's name - Phone number

• Insurance Company/Adjuster

• Encircle Work Auth

• Cause/s of water damage

  Select Toilet overflow Clogged drain Clogged gutter Water heater Sump pump Sewer backup Rubber/PVC supply line Air conditioning unit Inefficient drainage system Sprinkler systems Burst/leaking pipes Others (please specify)

  • Toilet overflow
  • Clogged drain
  • Clogged gutter
  • Water heater
  • Sump pump
  • Sewer backup
  • Rubber/PVC supply line
  • Air conditioning unit
  • Inefficient drainage system
  • Sprinkler systems
  • Burst/leaking pipes
  • Others (please specify)

• undefined

• Sign/s of water damage

  Select Water stains Mold or mildew Pools or puddles of water Sagging or soft spots Musty or damp odors Peeling or bubbling paint Structural damage Cracks on the ceiling or wall Swollen or warped materials

  • Water stains
  • Mold or mildew
  • Pools or puddles of water
  • Sagging or soft spots
  • Musty or damp odors
  • Peeling or bubbling paint
  • Structural damage
  • Cracks on the ceiling or wall
  • Swollen or warped materials

• Take photos of water damage for insurance claims.

Water Damage Inspection

• Identified and stopped the flow of the water source/s?

  Yes

  No

  N/A

• Water source/s

• Contamination level

  Little to none

  Has contaminants

  Hazardous/highly contaminated

• Water contamination category

  Category 1: White Water

  Category 2: Gray Water

  Category 3: Black Water

• Wet porous materials % of surface area

  Less than 5%

  5% to 40%

  More than 40%

• Low evaporation materials (such as carpet, gypsum board, fiber-fill insulation, Concrete Masonry Unit (CMU) and textiles) level of moisture absorption

  Minimal

  Significant

• Water damage class

  Class 1

  Class 2

  Class 3

  Class 4

Water Extraction

• Water Extracted

  Yes

  No

  N/A

• Extraction equipment used

  Select Industrial vacuums Submersible pumps Portable wet/dry vacuums

  • Industrial vacuums
  • Submersible pumps
  • Portable wet/dry vacuums

• Type of Surface and SQ ft

• Tools used to identify moisture

  Select Moisture meter Infrared thermal imaging

  • Moisture meter
  • Infrared thermal imaging

• Checked again for pockets of saturation?

  Yes

  No

  N/A

Drying and Dehumidification

• Opened windows and doors?

  Yes

  No

  N/A

• Turned on heavy-duty fans?

  Yes

  No

  N/A

• Used commercial-grade dehumidifiers?

  Yes

  No

  N/A

• Removed parts of walls and/or floors? If yes, add a note to give the reason why.

  No

  Yes

  N/A

Cleaning and Sanitation

Personal Protective Equipment

• Disposable clothing or protective overalls

• Rubber boots

• N-95 mask/respirator

• Goggles

• Gloves

Cleaning Equipment

• Used a negative air machine with HEPA filter/s?

  Yes

  No

  N/A

• Negative air machine/s used

  Select Vacuum Air scrubber Other type (please specify)

  • Vacuum
  • Air scrubber
  • Other type (please specify)

• undefined

• Used antimicrobial solution to clean surfaces?

  Yes

  No

  N/A

• Antimicrobial solution used

  Bleach and water

  Alcohol and water

  Other type (please specify)

• undefined

• Removed all mold and used mold control spray to prevent mold from reoccurring?

  Yes

  No

  N/A

Repair/Reconstruction

• Removed unsalvageable parts? (drywall below the flood line, low to medium density trim boards, carpet padding)

  Yes

  No

  N/A

• Sent carpet/s for deep cleaning?

  Yes

  No

  N/A

• Reused wooden trim boards?

  Yes

  No

  N/A

• Repaired drywall?

  Yes

  No

  N/A

• Major reconstruction necessary?

  No

  Yes

  N/A

• List or description of reconstruction needed:

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Media

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft

Rooms Affected

• Room Description

• Water Extracted

  Yes

  No

  N/A

• Extracted Material and Sq/Ft

• Photos Taken

  Yes

  No

  N/A

• Materials Removed and Sq/ft