Surface & Airborne Mould Testing - Mould Questionnaire

Step 1 of 6

16%

Name

First Last

Address

Street Address Address Line 2 Suburb State Post Code

Please ensure this field relates to the mould affected/expected home or property

Phone

Would our services be assisting you pre or post remediation?

Pre-remediation (no professional mould clean-up has been done)

Post-remediation (to assess professional clean up effectiveness)

I'm not sure

Occupants (Please list all occupants first name's, ages, room/s where most time is spent, any experienced health conditions/symptoms)

Are any of the above listed occupants smokers?

Yes

Quit

Who of the about listed occupants does this refer too? (please list first name/s)

Of the occupants of the home, would any spend more time at home than others?

Please list the first names of the occupants who spend the most time at home, and include an approximation of hours at home/day

Do you have any pets?

Yes

Which pets do you have?

Please list the first names of the pets and the type of animal

What is the type of home/ residence you have?

e.g., unit, duplex, weatherboard, brick, etc.

What is the foundation type of your home?

e.g., slab, stumps, basement, etc.

What year was your home built?

Approx. is acceptable

What is the m2 of your home?

Approx. is acceptable

How many floors/stories does your home have?

Approx. is acceptable

Please list the heating, air conditioning, fans that the home has:

Please add descriptions such as room names, and how often they are used

Please list the areas with visible mould:

Please add descriptions such as room names, location within the room and how extensive the mould is.

Please list the areas with a damp and musty odour:

Please add descriptions such as room names, and the severity of smell. Please don't include rooms with visible mould in this list.

Do these rooms smell at all times?

Yes

Sporadically

At periodic times of day

There are no smells or odours within my home

Was/is the area previously or currently water damaged?

Currently

Was previously

Please list the areas of current water damage:

Please add descriptions such as room names, location within the room and how extensive the water damage is.

Please list the areas of historical water damage:

Please add descriptions such as room names, location within the room and how extensive the water damage is. Please don't include areas with current water damage in this list.

Have you had renovations or internal changes to your home?

Yes

Have you made external or landscaping changes to your home?

Yes

Please list the changes that you have made to your home:

Please describe the location of the changes, when the renovation happened, and a brief description of the works.

Was water damage or visible mould the reason for these renovations or improvements?

Yes

Does your home experience flooding or drainage issues, or any specific areas of water pooling?

Yes

Please list the areas of affected flooding or pooling areas:

Please describe the location of the flooding/pooling and a brief description of if the flooding/pooling is current, historical or recurring, etc.

Has your home ever had any termite of pest issues?

Yes

Please list the areas of your home affected by termites or pests:

Please describe the location of the termite damage and a brief description of if pest problems are current, historical or recurring, etc.

Please provide any further information that you wish to make us aware of:

Images - Room 1

Max. file size: 50 MB.

Images - Room 2

Max. file size: 50 MB.

Images - Room 3

Max. file size: 50 MB.

Images - Room 4

Max. file size: 50 MB.

Images - Room 5

Max. file size: 50 MB.

Mould Questionnaire

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Mould Questionnaire

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