Damp and Mould Reporting Form

Latest revision date: Feb 2023
Revision Due Date: Feb 2025


Who is this form for?

Please use this form if you would like to report damp. Mould or condensation in your home. You can also use this form if you want to act on behalf of a tenant.

Protecting your personal Data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website
  • Who is completing this form?

  • I am filling this form out on behalf of: *

  • Who are they? *

  • Address of this person *

  • Name of the person you are contacting on behalf of *

  • Telephone number of this person *

  • Email Address of this person *

  • Do you have Authorisation to speak on behalf of this person? *

  • Your Details

  • Title *

  • First Name *

  • Last Name *

  • Address *

  • Phone Number *

  • Email Address *

  • About the Damp/Mould

  • Please tell us more about the location of the damp and mould in the room/s that the damp and mould is. *

    For example, is it on the ceiling? Is it on the bottom part of the wall? It is very wet to touch? Please include in here as much detail as you can including how much of a location the mould is covering.

  • Documents of proof

    You can upload the following file types: JPG, PDF, PNG
    Please note if you are going to save this form instead of submitting, you will need to upload your file when you submit.

  • When did you first notice the damp and mould? *

  • Have you reported this to us before? *

  • When did you do this? *

  • How have you reported this? *

  • What have we done about this? *

  • How many people are living in the property? *

  • Are there any resident in your home with any disabilities or health conditions? *

  • Are there any babies in your household? *

  • Are there any children in your household? *

  • Are there any people over 65 in your household? *

  • Does any of your household have any of the following health conditions? *

    Please tick all that apply

  • Tell us more about how these disabilities and health conditions and how this damp/mould and condensation is affecting these issues. *