PSS — First Response Intake Tool

1

Customer & Property

First name

Last name

Phone

Email (optional)

Property address

How found us

Property type

2

Loss Description

Date of loss

Time of loss (approx)

Source of water (brief description)

Is the water source stopped?

Estimated water category

Areas affected (check all that apply)

3

Safety Assessment

Electrical hazards?

Gas odor present?

Structural concerns?

Mold visible?

Displacement?

Sewage involved?

4

Scope & Estimated Size

Rooms affected (count)

Estimated sq ft affected

Water class estimate

Additional notes / scope

5

Dispatch

Responding technician

ETA given to customer

Pre-arrival notes for tech

6

Jobber Entry Summary

Complete fields above to generate intake summary...