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Initial Assessment & Reporting

3rd Party Name
3rd Party Reference #
RM Reference #
Attendance Date:
Attending Technician/s
- I confirm I have completed the Take5 & Submitted the electronic Take5 electronic form PRIOR to commencing works.
Date of Loss:
Who we Met on site?
- Business Hours
- After Hours
Property Type
- House
- Unit
- Commercial
Property Level/s
- Single
- Double
- Multi
Foundation Type
- Concrete
- Timber
- Concrete/Timber
Age of Property
Condition of Property:
- Good
- Poor
What has caused the incident to occur at the property?
- Burst flexi hose
- Leaking pipes from appliances
- Leaking taps or pipes
- Surface run off
- Sewage system failure
- River overflow or Tidal surge
- Washing machine / Bathroom overflow
- Burst water main
- Storm / Hail event
- Malicious Damage not a water event
- Fish Tank leak
Is the damage consistent with the event?
- YES
- NO
Has the leak / fault been rectified?
- YES
- NO
Your reason:
Category of Water Damage:
- CATEGORY 1 (‘originates from a sanitary water source’)
- CATEGORY 2 (‘significant contamination and has the potential to cause discomfort or sickness’)
- CATEGORY 3 (‘grossly contaminated and can contain pathogenic, toxigenic or other harmful agents’)
Class of Water Loss:
- Class 1 (‘less than 5% of combined floor, wall, and ceiling surfaces area exists and low-evaporation materials/assemblies have absorbed minimal moisture’)
- Class 2 (‘ 5% - 40% of combined floor, wall, and ceiling surfaces area exists and low-evaporation materials/assemblies have absorbed minimal moisture’)
- Class 3 (‘ more than 40% of combined floor, wall, and ceiling surfaces area exists and low-evaporation materials/assemblies have absorbed minimal moisture’)
- Class 4 (Deeply held or bound water - water intrusion with water that is hidden, trapped, or bound within low evaporation materials or low evaporation assemblies.)
Tell us a brief story:

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BUILDING / STRUCTURAL DAMAGES IDENTIFIED:

Do any electrical power outlets require an ‘electrical makesafe’
Has Electrician been appointed to carryout electrical makesafe?
Who has been contacted to carryout electrical makesafe?
(provide details of contact)
Has an Electrician been appointed?
- Yes
- N/A
Technician has sighted visible damage to carcass of unit
- Yes
- N/A
Technician has noted separation to ‘kicks’ of base of unit
- Yes
- N/A
Technician has noted separation to skirting boards within affected reported room/s
- Yes
- N/A
Technician has identified and recorded moisture wicking to gyprock sheeting within reported room/s
- Yes
- N/A
Technician has sighted microbial contamination to affected materials within reported room
- Yes
- N/A
Other areas requiring reporting
Authority to Remove & Dispose non-restorable flooring / contents has been signed off
- Yes
- N/A
Authority to Carry out Invasive works has been signed off
- Yes
- N/A
Authority to Leave on SIte form has been signed
- Yes
- N/A
Health Information and Consent to Proceed Form has been signed
- Yes
- N/A
Customer Responsibility Form - Instructions related to the restoration of your property
- Yes
- N/A
Request to M'Mnt - Detailed scope of works will need to be completed for the remediation process
- Yes
- N/A
e.g. details of additional works and approximate staff hrs req'd
Due to damage identified throughout property, it is recommended that insured be placed into emergency accommodation to allow the completion of structural drying and or mould remediation process
- Yes
- N/A
Satisfaction Release form has been signed off
- Yes
- N/A
Completion Certificate will be required to be completed
- Yes
- N/A
Insured has provided a ‘comment’ and or ‘video testimonial.
- Yes
- N/A
Technician has confirmed next attendance
- Yes
- N/A
Date
Untitled
- I confirm that all reporting has been completed
CONTENT/S DAMAGES IDENTIFIED:

Have reported contents have been sighted or recorded
- Yes
- No
- N/A
Contents affected have been manifested and completed.
- Yes
- No
- N/A
Numerous contents affected and a full manifest is to be completed as claim progresses.
- Yes
- N/A
Packout of contents will be required to allow for drying processes
- Yes
- N/A
Offsite cleaning and drying of decorative rugs will be undertaken, and has been manifested prior to removal from site
- Yes
- N/A
Electrical & Computer items have been affected and Specialised Trades’ have been appointed to assist in reporting
- Yes
- N/A
Electrical & Computer items have been removed from site for Specialised Trades to assist in reporting, items have been manifested prior to removal from site
- Yes
- N/A
Off site Laundering will be undertaken, items have been manifested prior to removal from site.
- Yes
- N/A
Other contents requiring reporting
Additional Info:
Scoped / Recommended Additional Approval/Authority to be obtained - is to be followed up by administration
- Yes
- N/A
Recommendation - Contents
Request to Leave Damaged contents/flooring onsite has been signed off
- Yes
- N/A
WORKS CARRIED OUT BY TECHNICIANS DURING INITIAL ATTENDANCE

JSA site risk assessment carried out Implemented safety measures and discussed with the other staff and clients on site.
- Yes
- N/A
WHS requires two technicians onsite to complete the makesafe and remediation works as per Company Policy and Procedures
- Yes
- N/A
Technician inspected the affected areas to confirm that the cause of the water loss has been fixed by plumber.
- Yes
- N/A
Technician inspected the affected areas to confirm that the cause of the water loss has yet still to be repaired by plumber.
- Yes
- N/A
Moisture Readings taken and recorded
- Yes
- N/A
Digital images recorded
- Yes
- N/A
Thermal images recorded
- Yes
- N/A
Furniture was relocated and placed onto blocks to prevent any further damage
- Yes
- N/A
Water was extracted from the affected areas
- Yes
- N/A
Treated carpet with a browning solution to remove and/or reduce water stains
- Yes
- N/A
Carried out steam extraction cleaning of carpeted areas
- Yes
- N/A
The carpet was dis-engaged and the underlay was removed and disposed
- Yes
- N/A
Carpet was removed and disposed from affected reported room/s
- Yes
- N/A
Carpet was uplifted to assist in the drying process
- Yes
- N/A
Technician has assessed numerous contents that were presented by insured as affected by event.
- Yes
- N/A
Contents deemed unrestorable were photographed and manifested.
- Yes
- N/A
Damaged contents have been disposed onsite in supplied skip bin or removed off site for disposal
- Yes
- N/A
Damaged content items have been left on site (LOS), awaiting approval to remove and dispose.
- Yes
- N/A
Technician has identified contents that are deemed restorable and these items have been safely removed from the premises for restoration offsite.
- Yes
- N/A
Contaminated affected skirting boards / building materials were safely removed, bagged and disposed from affected reported room/s
- Yes
- N/A
Hepa vacuum surface throughout affected areas to reduce airborne contaminates
- Yes
- N/A
Carried out micro-cleaning of contaminated materials -treated with antimicrobial / mould solution
- Yes
- N/A
Containment setup to reduce secondary damage
- Yes
- N/A
Contents were removed and relocated from the room to allow removal and disposal of damaged carpet and underlay
- Yes
- N/A
Contaminated and damaged smooth edging removed and disposed
- Yes
- N/A
Sample carpet left onsite with insured
- Yes
- N/A
Scheduled Skip Bin for disposal off damaged and contaminated materials
- Yes
- N/A
Off-site disposal of contaminated carpet and underlay (refuse tip / factory skip)
- Yes
- N/A
Storage of items (if applicable)
- Yes
- N/A

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ROOM 1 - FLOORING ASSESSMENT:

Affected Room - 1
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Define - other flooring type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 1 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 1 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
1. Have more rooms been affected?*
- Yes
- No

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ROOM 2 - FLOORING ASSESSMENT:

Affected Room - 2
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 2 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 2 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
2. Have more rooms got affected?*
- Yes
- No

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ROOM 3 - FLOORING ASSESSMENT:

Affected Room - 3
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 3 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 3 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
3. Have more rooms got affected?*
- Yes
- No

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ROOM 4 - FLOORING ASSESSMENT:

Affected Room - 4
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 4 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 4 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
4. Have more rooms got affected?*
- Yes
- No

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ROOM 5 - FLOORING ASSESSMENT:

Affected Room - 5
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 5 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 5 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
5. Have more rooms got affected?*
- Yes
- No

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ROOM 6 - FLOORING ASSESSMENT:

Affected Room - 6
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 6 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 6 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
6. Have more rooms got affected?*
- Yes
- No

Save and Continue Later

ROOM 7 - FLOORING ASSESSMENT:

Affected Room - 7
Room Size (mts)
Restorable or attempt to restore
Flooring Type
Flooring Construction
Flooring Condition
Underlay Type
Sub Floor Type
Approx Area affected
ROOM 7 - RELATIVE HUMIDITY & MOISTURE READINGS:

Relative Humidity %
Temperature (0 Celcius)
Carpet Moisture %
Gyprock Moisture %
Ceiling Moisture %
Concrete Moisture %
ROOM 7 - EQUIPMENT INSTALLED:

Equipment Status
Air Mover/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Dehumidifier/s
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Air Filtration Devices
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Boost Bar & Kit/Mats
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Direct-It-In Kit
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Containment Chamber
Enter Qty used, or if not used or applicable please enter 0 (the number 0)
Other:
------######### END OF THIS ROOM'S INFO #############------
Untitled*
- I confirm no more rooms were affected

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Recommendations:
Additional Info:
Recommended scoped works approval is to be followed up by administration
- Yes
- N/A
Request to Leave Damaged contents/flooring onsite has been signed off
- Yes
- N/A
Authority to Remove & Dispose non-restorable flooring / contents has been signed off
- Yes
- N/A
Authority to Carryout Invasive works has been signed off
- Yes
- N/A
Health Information and Consent to Proceed Form has been signed
- Yes
- N/A
Customer Responsibility Form - Instructions related to the restoration of your property
- Yes
- N/A
Detailed scope of works will need to be completed for the remediation process. Large loss / Detailed scope of work required by Supervisor
- Yes
- N/A
Due to damage identified throughout property, it is recommended that insured be placed into emergency accommodation to allow the completion of structural drying and or mould remediation process
- Yes
- N/A
Satisfaction Release form has been signed off
- Yes
- N/A
Completion Certificate will be required to be completed
- Yes
- N/A
Insured has provided a ‘comment’ and or ‘video testimonial.
- Yes
- N/A
Technician has confirmed next attendance
- Yes
- N/A
Date
Initials of Technician:
DISCLAIMER:

*Inspections are conducted in a conscientious and professional manner. However, it is possible that water [escape of liquid] may be present in areas that were inaccessible or visually obscured during the inspection. ReAssured Restoration takes no responsibility for water damage to contents and/or structure or mould growth that may occur as a result of the delayed response in allowing restorative drying or treatment to be carried out in a timely manner. Whilst all care is undertaken in the provision of contracted services, no responsibility is accepted for claims, losses or liability alleged by third parties (for whatever reason) and liability to any such party is expressly excluded to the extent permitted at law.*
Technicians to read thoroughly answer and initial the following
Description of Purchase Order correlates to works carried out for
- Qty rms to be remediated
- Qty and type of equipment being paid for
- Works listed to be carried out
- # of days authorised for remediation
Is longer dry time required?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Drill kicks required and not already in p/o?
- Yes
- N/A
Have kicks been drilled
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Removal of skirting boards required
- Yes
- N/A
Have skirting boards been removed?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Containment established?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Air scrubber used?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Mould Testing required?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Drug testing required?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Items disposed of?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
2 Staff required onsite to relocate heavy furnishings due to OH&S requirements?
- Yes
- N/A
If yes, has p.o been requested?
- Yes
- No
If yes, has authorisation been received?
- Yes
- No
Name of 3rd Party contact that gave authorisation to proceed with extra works, include time
Any other comments
Total Equipment installed
Additional Rooms - Other:
Technician Initials

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