| Where is the damage located? | How large is the affected area? What are the signs of Damage? | How long have you been aware of problem? | What materials are damaged? |
| Interior rooms Bathroom or kitchen Window sills/trim Flooring Ceiling Walls Attic Basement or under crawl space Exterior of house (siding, trim, eaves) Roofing Deck, porch or other structure Wooden fencing or retaining wall | Currently damp or wet Soft, rotten or powdery surfaces Moldy appearance or odor Water stains or discoloration Buckled wood or wallboard Peeling paint Evidence of insects Other | Select possible causes of the water damage. Toilet overflow Pipe burst Fire sprinkler went off Sink overflow Washing machine hose Drain back-up Roof leak Slow or gradual leak or water exposure Other Don’t Know | Wallboard Vinyl Flooring Hardwood floor Wood sub-floor Tile or grout Cabinetry or wood trim Wood framing materials Insulation Exterior wood Stucco |
