Select all that Apply *

Immediate action is necessary to remedy an issue

The issue is causing, or is likely to cause damage to the building

Inability to inhabit or use the building (or part of the building) for its intended purpose

Risk to health or safety

Risk of further damage to the building (or part of the building)

Impacts of the issue, or likely impacts, are serious in nature

Class of Building

Class 1a or 1b

Class 2 or above

Unknown

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country