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

Brief Summary Of Loss

INSPECTION NOTES

Section I. Dwelling Roof (General)

Is the roof related to the claim?

Inspected

RoofAge

Waste Factor

Roof Material

Roof Pitch

Roof Levels

Risk Condition

Roof Layers

Gutters

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:

List Roof Accessories:

Evidence of Prior Repairs:

Brittle Test?

Unrelated Damage Observed?

Section II. Exterior Elevations(s)

Is there damage on the front elevation?

If yes, briefly explain:

Is there damage on the right elevation?

If yes, briefly explain:

Is there damage on the rear elevation?

If yes, briefly explain:

Is there damage on the left elevation?

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?

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?

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?

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