Property Damage Assessment Form

Restoration services

Property damage assessment form

Please complete this form to help our team accurately assess the affected areas and provide you with the best possible restoration plan.

Claim / File #

Client information

First name

Last name

Phone number

Email address

Property address

Property type

Date / time of loss

Loss details

Type of water intrusion

Approximate water depth at peak

Source stopped / controlled?

Has standing water been removed?

Brief description of the loss event

Affected floors

Check all floors where damage is present or suspected.

Basement (Below Grade) Ground Floor / Main 2nd Floor 3rd Floor Crawl Space Attic / Roof Space

Room-by-room inventory

List each affected room. Estimate size and identify the flooring type and approximate damage level.

Contents & belongings

Check all that apply in the affected areas.

Furniture Electronics / Appliances Clothing / Textiles Documents / Files Personal Valuables Storage Boxes / Bins Area Rugs No Contents Affected

Additional notes on contents

Building conditions

Is the property currently occupied?

Is the property accessible 24/7?

Electricity available?

Any known mould / odour present?

Any hazardous materials concern?

Year property was built (approx.)

Additional building notes

Insurance information

Insurance company

Policy / claim number

Adjuster name (if known)

Adjuster phone

Has a claim been filed?

Deductible amount (if known)

Declaration

By signing below, I confirm that the information provided in this form is accurate to the best of my knowledge and that I authorize the restoration team to access the property for assessment purposes.

Client signature

Draw your signature above using your mouse or finger.

Date

Your signed form and all details above are sent to info@revitareno.ca.

info@revitareno.ca · (437) 525-0030