Damp and mould reporting form

Please select the answer that applies*

I’m the resident (or I am completing on behalf of the resident)

I’m a member of the Havebury team completing the form on a resident’s behalf

I’m a Havebury contractor completing the form on a resident’s behalf

Is this the first time you are reporting an issue to us?*

Name*

First Last

Name of organisation*

Name of person completing the form on a resident's behalf*

First Last

Name of resident*

First Last

Resident Address

Street Address Address Line 2 City County Postcode

Resident's Email

If you want a PDF sent to you to confirm what you have put in this form, please provide your email address below.

Resident's Phone number*

What room/s are being affected by damp, mould or condensation?

Please provide as much detail as possible. Including whether you are experiencing any issues in outbuildings you have

What areas of the room/s can you see affects of damp, mould or condensation?

For example – Is it just around the windows, it is on the ceiling or walls, it is all around the bath/shower area? Is the damp or mould inside your home on an internal wall (a wall that separates rooms) or on an external wall (a wall that faces outside)?

How much damp, mould and condensation can you see in the room/s?

For example, is it half the room or just around the corners of the walls. Is it just around the window sill or on the ceiling?

Please let us know what you use to ventilate your home.

This includes extractor fans, trickle vents, positive ventilation (PIV) units. Please also let us know if these are working properly.

Please let us know approximately how long you've been having these issues. Also include whether we previously resolved the issues and they've since come back.

This will help us understand what work needs to be carried out to resolve this for you.

Have you had any major leaks in the last 12 months?

Yes

If yes, where in your home was the leak?

During our inspection, we can check to make sure this area is fully dried out from the leak.

Is your heating system currently working and how often do you use it?

In some instances, we may need to carry repairs out quicker because someone living in your home is classed as vulnerable. The next few questions will help us understand this more.

Do you have any dependents under the age of 14 living in your home?*

Yes

Is anyone who lives in your home over the age of 65 years old?*

Yes

Could anyone living in your home be pregnant?*

Yes

Does anyone in your home have a health problem that could get worse because of damp or mould?

For example, this could include skin problems like eczema, breathing problems like asthma, or a weak immune system (for example, if someone is having chemotherapy). If you’re not sure, but think it might be relevant, please tell us a bit more if you feel comfortable doing so.

Please upload any images you have below.

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.