Report mould or condensation

Your name:

Your address:

Your postcode:

Your contact number:

Total number of people in your home:

Number of bedrooms:

Levels of mould

Have you experience mould in the last 3 years?

Yes

No

Which rooms are affected by mould (please tick appropriate boxes):

Bathroom

Yes

No

What area in the bathroom?

Please state what level the mould is:

Toilet

Yes

No

What area in the toilet?

Please state what level the mould is:

Bedroom

Yes

No

What area in the bedroom?

Please state what level the mould is:

Living room

Yes

No

What area in the living room?

Please state what level the mould is:

Kitchen

Yes

No

What area in the kitchen?

Please state what level the mould is:

Hallway

Yes

No

What area in the hallway?

Please state what level the mould is:

Condensation

Does your home show any signs of condensation e.g. water droplets on your windows (please see example photo above)

Yes

No

Leak information

Have you experienced a leak into your home in the last 3 months?

Yes

No

Are you currently experiencing a leak?

Yes

No

Is there mould in the area where the leak is?

Yes

No

Where is the leak?

Please state what level the mould is:

Extractor fans

Do you have an extractor fan in your bathroom?

Yes

No

Does it work?

Yes

No

Do you have an extractor fan in your toilet?

Yes

No

Does it work?

Yes

No

Heating

Do you know how to use your boiler?

Yes

No

Do you have any concerns about your energy usage?

Yes

No

Does your heating work sufficiently?

Yes

No

Please provide details:

Do you or any household members currently suffer from any health issues?

Yes

No

Please provide details:

Do you have any other comments or details?