Mold Exposure Assessment

Mold Exposure Assessment
Evaluate potential mold exposure risks and symptoms in your property or environment.
Property Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Your Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What type of property is being assessed?
Other
Environmental Observations
Rows Observed Severity (1-Low, 5-High)
Visible mold growth 1
Musty or moldy odor 3
Water leaks or damage 5
Condensation on windows/walls 7
High humidity (over 60%) 9
Have you or others in the property experienced any of the following symptoms?
Other
How long have these symptoms been experienced (if any)?
Rate your level of concern about mold exposure in this property.

1
2
3
4
5
1 is Not concerned, 5 is Extremely concerned
What actions (if any) have been taken to address mold or moisture problems?
Should be Empty:

Rows	Observed	Severity (1-Low, 5-High)
Visible mold growth	1
Musty or moldy odor	3
Water leaks or damage	5
Condensation on windows/walls	7
High humidity (over 60%)	9

Select theme: