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Household Clean-Up and Repair Needs

"I can collect more specific information about any damage to your home and document any assistance you need to ensure it is safe to live in. We will share this detail with emergency management and/or clean-up agencies that may be able to assist. Let’s review?"

Document Resource Needs

Owner / Tenant

Client's Listing of Damage

Chimney collapse
- Required
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$
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Chimney damage
- Required
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$
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Damage to roof 'decking'
- Required
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$
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Gutter damage
- Required
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$
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Loose or broken siding
- Required
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$
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Major structural components destroyed
- Required
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$
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Minor roof damage
- Required
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$
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Roof collapse of failure
- Required
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$
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Home has shifted from foundation
- Required
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$
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Structure is in immediate danger from landslide, mudslide, sinkhole, etc.
- Required
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$
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Two or more walls have been destroyed
- Required
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$
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Black mold
- Required
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$
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Damage to clothing and personal belongings
- Required
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$
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Damage to drywall
- Required
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$
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Damage to floor coverings
- Required
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$
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Damage to furniture
- Required
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$
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Damage to insulation (torn, wet, damp, missing, etc.)
- Required
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$
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Damage to refrigerator and/or freezer
- Required
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$
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Damage to washer/dryer
- Required
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$
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Damage to water heater
- Required
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$
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Damage to furnace
- Required
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$
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Horizontal foundation cracks larger than 2 inches (new)
- Required
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$
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Vertical foundation cracks (new)
- Required
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$
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Water is in electrical outlets
- Required
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$
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Other (specify)
- Required
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$
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Additional Assistance Needed

Clean-up kit (self-cleaning)
- Required
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$
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Debris Removal - from house
- Required
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$
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Debris Removal - from basement
- Required
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$
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Debris Removal - from yard
- Required
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$
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Tree Removal - from house
- Required
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$
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Tree Removal - from yard
- Required
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$
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Mold Remediation
- Required
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$
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Gutting/Muck-out (cleaning up damage to and in home)
- Required
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$
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Roofing - Tarping
- Required
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$
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Roofing - Repair
- Required
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$
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Roofing - Replacement
- Required
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$
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Water Removal
- Required
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$
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Utility Replacement
- Required
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$
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Other (specify)
- Required
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$
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Document Housing Needs

Clean-up kit (self-cleaning)
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$
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Debris Removal - from house
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$
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Debris Removal - from basement
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$
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Debris Removal - from yard
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$
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Tree Removal - from house
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$
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Tree Removal - from yard
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$
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Mold Remediation
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$
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Gutting/Muck-out (cleaning up damage to and in home)
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$
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Roofing - Tarping
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$
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Roofing - Repair
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$
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Roofing - Replacement
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$
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Water Removal
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$
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Utility Replacement
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$
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Other (specify)
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$
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Add Alternate Contact
Notes
- Required
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$
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MI 2-1-1 All rights reserved.