Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Site of water damage
  • Client's name - Phone number

  • Insurance Company/Adjuster

  • Encircle Work Auth

Water Damage Restoration

  • Cause/s of water damage

  • undefined

  • Sign/s of water damage

  • Take photos of water damage for insurance claims.

Water Damage Inspection

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

  • Water source/s

  • Contamination level

  • Water contamination category

  • Wet porous materials % of surface area

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

  • Water damage class

Water Extraction

  • Water Extracted

  • Extraction equipment used

  • Type of Surface and SQ ft

  • Tools used to identify moisture

  • Checked again for pockets of saturation?

Drying and Dehumidification

  • Opened windows and doors?

  • Turned on heavy-duty fans?

  • Used commercial-grade dehumidifiers?

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

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?

  • Negative air machine/s used

  • undefined

  • Used antimicrobial solution to clean surfaces?

  • Antimicrobial solution used

  • undefined

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

Repair/Reconstruction

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

  • Sent carpet/s for deep cleaning?

  • Reused wooden trim boards?

  • Repaired drywall?

  • Major reconstruction necessary?

  • List or description of reconstruction needed:

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

Rooms Affected

  • Room Description

  • Water Extracted

  • Extracted Material and Sq/Ft

  • Photos Taken

  • Materials Removed and Sq/ft

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.