RECOVERY TEAM
Town of Jamestown, CO
Telephone 303-449-1806
	
Property Assessment for Volunteer Efforts
The purpose of this form is meant to assist the Recovery Team in identifying outstanding flood recovery work for the residents of Jamestown.  This is an informal case management review that will allow the team to match volunteer labor and donated resources with resident need. 

Resident Name:    __________________________	Date:  _____________________
Physical Address:  _________________________________________________________
Home Telephone:  ______________  Cell:  _______________  Work:  ______________
Email:  ____________________

Best Method of Communication:  ________________  Best Time to Contact:  ________

Are you REBUILDING  _____  or REPAIRING  ____?

Do you need to demo your home? (Assistance available):  _________

Would you like information about demolition options?:  __________

If you  have a demolition plan please share?  Who:_________________________________________
When:  _______________________________________
How:  ________________________________________

Do you need financial assistance for your project?  _____  volunteer assistance  ____?

Do you have family or friends who want to help you with your project?  __________

Have you had your home checked/assessed by a structural engineer?  ____  
If yes, please provide the following:
Name of Structural Engineer:  ___________________________________________
Summary of results (copy of report if available):  

Did water come into your home?  ____  If so, how high?  ____

Did you lose your septic tank/system?  ____

Have you replaced any of the following items in your home?  
□	Dry wall	
□	Flooring	

□	Furnace	
□	Hot water heater	

□	Roofing	
□	Insulation	

□	Other:  ______________________	

Have you or someone else mitigated for mold in your home?  _______________
If so, who mitigated and what did they/you do?  ___________________________________________________________________

Which of the following did you remove in your home?:
□	Belongings	
□	Appliances	

□	Carpeting	
□	Sub-floor	

□	Dry wall (partial)	
□	Flooring	

□	Dry wall (all)	
□	Insulation	

Other:  ____________________________

	□		□		
What do you currently need to do on the interior of your home?:
Floors	
□	Install floor joists	□	Install sub-floor	
□	Install flooring
o	Carpet
o	Hard-wood
o	Linoleum
o	Vinyl	□	Other:  _____________________	
Walls	
□	Install insulation	□	Install dry wall (hang, mud, sand)	
□	Paint	□	Other:  _____________________	
Electrical	
□	Electrical replacement (outlets, light switches)	□	Upgrade Electrical panel	
□	Move electrical boxes	□	Other:  _____________________	
Plumbing	
□	Kitchen Sink	□	Bathroom Sink	
□	Dishwasher	□	Toilet	
□	Garbage Disposal	□	Bathtub	
□	Other:  _____________________		
Heating	
□	Replace ducts	□	Replace system	
□	Wood Stove	□	Other:  _____________________	
Appliances	
□	Range/Stove	□	Washer	
□	Dishwasher	□	Dryer	
□	Refrigerator	□	Chest freezer	
□	Other:  _____________________		

What would you like to do on the exterior of your property?:
□	Replace rock walls or planters	□	Tree removal	
□	Scrape rock debris from yard	□	Uncover paths/grass	
□	Collect flood debris	□	Lay paths	
□	Remove flood debris	□	Fencing	
□	Decking	□	Other:  ________________________	

	AUTHORIZATION FORM
Town of Jamestown, CO
Telephone 303-449-1806	

Must be Signed Before Work Can Begin

I, (Print Name)  _______________________________________________________________
Hereby release from liability and agree to hold harmless the volunteers involved in Jamestown cleanup efforts harmless from any damage or injury that may occur on my property, including personal property or to my person, which may occur during the cleanup/rebuild operation.  I further understand and agree that there is no warranty, implied written or oral, for any work performed on my property by said volunteers.  I understand that there are limits on volunteers financial and material resources and there is no guarantee that said service will be provided.

Additionally, I further understand that THIS IS NOT A CONTRACT TO PROVIDE SERVICES.

I give permission to the Volunteer Coordinator to access my property to inspect the work that is listed above.  The Volunteer Coordinator will attempt to contact me by preferred contact method before accessing property.
Initial :_____

Property Owners Signature:
________________________________________________

Date this __________ day of   _________________, 2014

	INTERNAL FORM
Town of Jamestown, CO
Telephone 303-449-1806	
Notes About Specific Property

Description/Notes of Work Order:

Completed By:  _____________________________		Date:   _____________________________
Time Started:   _____________________________		Time Ended:  _______________________