Hello, John!

Preliminary Damage Assessment

“We will gather some general information about any damage to your home now. This may be shared as preliminary, property-specific damage assessment with emergency management for their reporting purposes.”

Document Resource Needs

Owner / Tenant

Client's Listing of Damage

Is the residence accessible?
- Required
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Do you have water damage in your basement?
- Required
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$
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If yes, What depth is the water in your basement?
- Required
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$
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If yes, Is your basement essential living space?
- Required
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$
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If yes essential living space, Please describe the essential living space:
- Required
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If yes, Do you have water in your crawl space?
- Required
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$
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Do you have water in your main living area?
- Required
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If yes, What is the depth of water in your main living area?
- Required
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If yes, How many rooms are affected in your main living area?
- Required
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Do you have foundation damage?
- Required
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Do you have furnace or A/C damage?
- Required
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$
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Do you have mold damage?
- Required
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$
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Is your home insured for damages?
- Required
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Additional Assistance Needed

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Document Housing Needs

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Add Alternate Contact
Notes
- Required
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