Adjuster Information

Adjuster First Name

Adjuster Last Name

Adjuster Email *

Adjuster ID

Home Owner

StartTime

PST

Client Token

General Notes

Structure Type

# of Families

# of Stories

Exterior

Usage

Year Built

Foundation

Occupancy

Cause and Origin

Cause

Wind
Hail
Water (Non-Weather)
Fire
Lightning
CAT
Flood
Other
Liability
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Brief Summary Of Loss

INSPECTION NOTES

Section I. Dwelling Roof (General)

Is the roof related to the claim?

Yes
No
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Inspected

RoofAge

Waste Factor

Roof Material

Roof Pitch

Roof Levels

Risk Condition

Roof Layers

Gutters

Fastened
Spiked/Nailed
Absent
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Eave Overhang nMeasurement

Fascia Measurement

Dwelling Roof (Damage Count)

Front Slope Damage Count:

Right Slope Damage Count:

Rear Slope Damage Count:

Left Slope Damage Count:

RoofAccessories:

Collateral Damage:

Yes
No
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List Roof Accessories:

Evidence of Prior Repairs:

Brittle Test?

Unrelated Damage Observed?

Section II. Exterior Elevations(s)

Is there damage on the front elevation?

Yes
No
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If yes, briefly explain:

Is there damage on the right elevation?

Yes
No
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If yes, briefly explain:

Is there damage on the rear elevation?

Yes
No
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If yes, briefly explain:

Is there damage on the left elevation?

Yes
No
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If yes, briefly explain:

Unrelated Conditions Observed:

Section III. Interior

1. Level

1. Room Name

1. Scope of Damages:

1. Personal Property Damaged:

2. Level

2. Room Name:

2. Scope of Damages:

2. Personal Property Damaged:

3. Level

3. Room Name:

3. Scope of Damages:

3. Personal Property Damaged:

4. Level

4. Room Name:

4. Scope of Damages:

4. Personal Property Damaged:

5. Level

5. Room Name:

5. Scope of Damages:

5. Personal Property Damaged:

Is there any other property damage?

Yes
No
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6. Level

6. Room Name:

6. Scope of Damages:

6. Personal Property Damaged?:

7. Level

7. Room Name:

7. Scope of Damages:

7. Personal Property Damaged:

8. Level

8. Room Name:

8. Scope of Damages:

8. Personal Property Damaged:

9. Level

9. Room Name

9. Scope of Damages:

9. Personal Property Damaged:

10. Level

10. Room Name1:

10. Scope of Damages:

10. Personal Property Damaged:

Do you have any other damages?

Yes
No
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11. Level

11.Room Name:

11. Scope of Damages:

11. Personal Property Damaged:

12. Level

12. Room Name:

12. Scope of Damages:

12. Personal Property Damaged:

13. Level

13. Room Name:

13. Scope of Damages:

13. Personal Property Damaged:

14. Level

14. Room Name:

14. Scope of Damages:

14. Personal Property Damaged:

15. Level

15. Room Name:

15. Scope of Damages:

15. Personal Property Damaged:

Section IV. Other Structure(s)

1. Type of Structure:

1. Scope of Damages:

1. Unrelated damages:

2. Type of Structure:

2. Scope of Damages:

2. Unrelated damages:

3. Type of Structure:

3. Scope of Damages:

3. Unrelated damages:

4. Type of Structure:

4. Scope of Damages:

4. Unrelated damages:

5. Type of Structure:

5. Scope of Damages:

5. Unrelated damages:

Do you have any more damage to other structures?

Yes
No
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6. Type of Structure:

6. Scope of Damages:

6. Unrelated damages:

7. Type of Structure:

7. Scope of Damages:

7. Unrelated damages:

8. Type of Structure:

8. Scope of Damages:

8. Unrelated damages:

9. Type of Structure:

9. Scope of Damages:

9. Unrelated damages:

10. Type of Structure:

10. Scope of Damages:

10. Unrelated damages:

Section V. Other Notes

Claim Other Notes