Please complete the information below as fully as possible and click the submit button to send it to us electronically.
Alternatively, if you would prefer to submit your information by post click here to download a printable version of this form in Microsoft Word format.
In the following, please tick all relevant boxes, delete where applicable* and reply where you can.
1. Has your property ever been flooded? Yes No Don't Know
How many times have you flooded and when?
a. In the last year?
b. In the last five years?
c. In the last ten years?
d. In the last 50 years?
e. When did your property last flood?
f. I don't know
2. What was the source of the flood water - where did it come from?
River (give name below) Stream or Brook Ground Water Water from hills Highway Flooding Runoff Sewers / Drains/ Manholes Other (please give details)
Name of River/Stream
3. Flooding History (if the property has flooded several times, please record the most severe flood event)
a. What was the maximum depth of floodwater
Inside
Outside
b. How long did the floodwater remain?
c. The floodwater that came in was don't know clean dirty sewage
d. How much warning of the flood did you have? don't know minutes hours days
e. Did you receive a formal flood warning? don't know yes no
f. How many able bodied people will help you in a flood event? 1 2 3 more
g. Will you leave protection in place for extended periods when you are away? don't know yes no
h. Would you like a flood Alarm fitted? don't know yes with autodialer facilities yes no autodialer facilities no
4. Extent of Flooding:
Land or site area Main Property OutbuildingsOther
If other please specify
5. How did floodwater get into your property?
a. Through doors Front Back Patio Other Don't Know
b. Through windows Front Back Sides Other Don't Know
c. Through airbricks Front Back Sides Other Don't Know
d. Through drains. WC Bath Sink Other Don't Know
e. Through walls. Front Back Sides Other Don't Know
f. Through floors. Front Back Sides Other Don't Know
g. Into cellar or basement Front Back Sides Other Don't Know
h. Other please specify
6. The type of property you want to be surveyed
a. Pub/Restaurant Detached Semi-detached Terraced Single Storey
b. Commercial Detached Semi-detached Terraced Single Storey
c. Public Detached Semi-detached Terraced Single Storey
d. Utility Building Detached Semi-detached Terraced Single Storey
7. Property construction details - if you know them.
a. Walls. Don't Know Brick Masonry/Stone Solid Walls Cavity Walls Blockwork Concrete with rendering Timber Timber frame with brick cladding
b. Floors. Don't know Suspended Timber Beam and Block Solid Concrete
c. Cellars - if you have one? Is it used? Yes No
How deep?
8. Condition of lower wall / courses of brick / stonework
Don't know Good Satisfactory Poor
9. Listing / Conservation Area - is your building:
Not listed or in a conservation area?
Listed Grade I?
Listed GradeII?
In a conservation area?
Otherwise subject to permission for exterior works i.e.Leasehold?
Don't know
10. Risk - as defined by the Environment Agency and / or your insurers:
Is your property at Don't know Low Moderate Significant risk of flooding?
Would you consider the risk of your property flooding over the last ten years has been:-
Don't know Increasing Decreasing Static
11. Insurance
a. Are you insured for flood damage?
Don't Know Yes No
b. Have you been refused flood cover?
c. Who is your insurer?
d. Do you have a higher premium because of flood risk?
e. Do you have an excess on a flood claim for contents?
Don't Know Yes No Excess
f. Do you have an excess on a flood claim for buildings?
12. If you were to be protected by a barrier / aperture system, what do you think should be the barrier height above ground level (based on how high the floodwater might come)?
Required height Don't Know Less than 30cm (1ft) 30cm (1ft) 60cm (2ft) 90cm (3ft) More
If more please state height required
13. Other relevant information or facts?
14. Sketch Plan of property (a rough outline will do with if possible dimensions and positions of key openings like doors, patio doors low windows etc.)
If you have the ability to scan in your sketch please e-mail to us at info@flodef.com with the first line of your properties address as the subject line.
Your contact information
Company Name
VAT No
Name
Address
Postcode
Daytime Telephone number
E-mail address
Type of Business
Property Use
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