Title Page
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Site conducted
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Conducted on
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Prepared by
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Site of water damage
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Client's name - Phone number
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Insurance Company/Adjuster
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Encircle Work Auth
Water Damage Restoration
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Cause/s of water damage
- 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)
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Sign/s of water damage
- 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
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Take photos of water damage for insurance claims.
Water Damage Inspection
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Identified and stopped the flow of the water source/s?
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Water source/s
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Contamination level
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Water contamination category
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Wet porous materials % of surface area
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Low evaporation materials (such as carpet, gypsum board, fiber-fill insulation, Concrete Masonry Unit (CMU) and textiles) level of moisture absorption
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Water damage class
Water Extraction
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Water Extracted
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Extraction equipment used
- Industrial vacuums
- Submersible pumps
- Portable wet/dry vacuums
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Type of Surface and SQ ft
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Tools used to identify moisture
- Moisture meter
- Infrared thermal imaging
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Checked again for pockets of saturation?
Drying and Dehumidification
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Opened windows and doors?
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Turned on heavy-duty fans?
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Used commercial-grade dehumidifiers?
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Removed parts of walls and/or floors? If yes, add a note to give the reason why.
Cleaning and Sanitation
Personal Protective Equipment
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Disposable clothing or protective overalls
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Rubber boots
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N-95 mask/respirator
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Goggles
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Gloves
Cleaning Equipment
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Used a negative air machine with HEPA filter/s?
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Negative air machine/s used
- Vacuum
- Air scrubber
- Other type (please specify)
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Used antimicrobial solution to clean surfaces?
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Antimicrobial solution used
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Removed all mold and used mold control spray to prevent mold from reoccurring?
Repair/Reconstruction
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Removed unsalvageable parts? (drywall below the flood line, low to medium density trim boards, carpet padding)
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Sent carpet/s for deep cleaning?
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Reused wooden trim boards?
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Repaired drywall?
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Major reconstruction necessary?
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List or description of reconstruction needed:
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft
Rooms Affected
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Room Description
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Water Extracted
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Extracted Material and Sq/Ft
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Photos Taken
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Materials Removed and Sq/ft