Download Here - James L. Schaller, M.D., M.A.R., P.C

Environmentally Friendly Mold Remediation Techniques That Significantly Reduce Childhood AsthmaTelephone Interview LogOccupant Information:Name:________________________________________________Location: _____________________________________________Phone Number: ________________________________________Alternate Phone Number:_________________________________E-mail Address:_________________________________________Initial Notification: Date:_______________Time:______________Interview Questions1. Type of water intrusion (plumbing, windows, roofing, etc.):__________________________________________________2. When did you first notice the problem? ____________________3. Can you see where the water is coming from?If yes, where:__________________________________________________________________________________________4. Rooms affected: _________________________________________________________________________________________________________________________________________5. Type of damage (discoloration, musty/moldy odors, flooring,cabinets, etc.):____________________________________________________________________________________________________6. Category of water (circle one): Clear Gray Black7. Approximate size of damage (10 square feet or less, 10 - 25 squarefeet, >25 square feet):____________________________________________________________________________________________________131