WATER LEAK INSURANCE CLAIM RECORD
Editorial worksheet from Leak Insurance Claim, published by ADI Leak Detection.
Not an insurer form or confirmation of cover. Notify your insurer promptly; do not wait for a complete file.
Complete locally or print. This website does not receive the completed record.

INCIDENT
Property / policyholder:
Insurer / claim reference / claims contact:
Date first noticed (not an estimate of when the leak began):
Room / observations:
Safe emergency actions / contractor / time:

PHOTOGRAPH INDEX (repeat per file)
File name / room / date:
What the image shows:
Before or after intervention:

DOCUMENT REGISTER (repeat per report or invoice)
Document / author / date / version:
What request it answers:
Sent to / secure channel / date:
Acknowledgement received:

APPROVAL RECORD (repeat per scope)
Work proposed:
Person authorising / date / written reference:
Agreed scope / limit / conditions:
Items still awaiting approval:

OUTSTANDING ACTIONS
Question / missing document:
Person responsible:
Requested date / agreed next update:
Response / document reference:

Keep original files and dated corrections together. Use copies for submissions.
Do not delay safety work to obtain photographs or enter unsafe areas to complete this record.