Free Insurance Damage Report Template
INSURANCE DAMAGE REPORT
May 15, 2055
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Reported by: [Your Name] Company Name: [Your Company Name] Approved by: Drake Feeney, Supervisor |
Claim Number: BFI-789123 Policy Number: BFI-980765 Date of Incident: May 13, 2055 |
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Time of the Incident: |
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I. Incident Details
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Type of Damage: Water Damage
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Location of Incident: Orlando, FL 32801
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Description of Damage:
On May 13, 2055, a heavy rainstorm caused flooding in the basement. Water entered through a broken window seal, damaging the flooring and several personal items. The water reached up to 2 feet deep in some areas.
II. Property Information
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Property Affected |
Basement |
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Estimated Damage Amount |
$8,000 |
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Photographs Included |
Yes |
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Additional Documentation |
Repair receipts and photos |
III. Witness Information
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Witness Name: Lester Nolan
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Witness Contact Information: (555) 987-6543
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Witness Statement:
Lester Nolan, a neighbor, saw the water rising and immediately informed the homeowner. He helped move some personal belongings from the basement to prevent further damage.
IV. Actions Taken
Immediate Actions Taken:
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The homeowner contacted a water damage restoration service to remove the water.
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Temporary repairs were made to the broken window seal.
Repairs/Replacement Needs:
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Repair Needed |
Action |
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Flooring Replacement |
Install new carpet and tiles |
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Window Seal Repair |
Permanent seal installation |
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Electrical Inspection |
Full inspection by a licensed electrician |
V. Additional Information
The homeowner has scheduled full repairs with a contractor and is awaiting approval from insurance to proceed.
