3 Column Adjuster Worksheet

Financial worksheet for calculating a repair estimate, with one column to itemize losses, and 3 columns for replacement cost, depreciation, and actual cash value.

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4 Column Adjuster Worksheet

Financial worksheet for calculating a repair estimate, with one column to itemize losses, and 4 columns for replacement cost, quantity or age, depreciation, and actual cash value.

Manufactured (Mobile) Home/Travel Trailer Worksheet (FEMA Form 086-0-17, 4/14)

This form is used by the adjuster to record information to determine the replacement cost and actual cash value of a manufactured (mobile) home. NOTE: This form is currently under review at the Office of Management and Budget (OMB) and has expired effective April 30, 2017. However, OMB has authorized the continued use of the existing form, until the review process is complete. Upon OMB approval, FEMA will update this record with the new form.

Worksheet Contents Personal Property (FEMA Form 086-0-6, 4/14)

The adjuster and the policyholder list and assess the inventory of flood-damaged personal property on this form. NOTE: This form is currently under review at the Office of Management and Budget (OMB) and has expired effective April 30, 2017. However, OMB has authorized the continued use of the existing form, until the review process is complete. Upon OMB approval, FEMA will update this record with the new form.

Worksheet-Building (FEMA Form 086-0-7, 4/14)

This form is used by adjusters and policyholders to list and assess the scope of flood damaged building property. NOTE: This form is currently under review at the Office of Management and Budget (OMB) and has expired effective April 30, 2017. However, OMB has authorized the continued use of the existing form, until the review process is complete. Upon OMB approval, FEMA will update this record with the new form.

Worksheet-Building-Continued (FEMA Form 086-0-8, 4/14)

This form is a continuation sheet used by the adjuster and policyholder to list and assess the amount of building property damage. NOTE: This form is currently under review at the Office of Management and Budget (OMB) and has expired effective April 30, 2017. However, OMB has authorized the continued use of the existing form, until the review process is complete. Upon OMB approval, FEMA will update this record with the new form.

ACORD 41 - Residential Property Replacement Cost Worksheet

An ACORD form for calculating the replacement cost of a residential dwelling using the Boeckh square foot method. This form is used by insurance agents to determine how much coverage should be written when an application is submitted, and by insurance claims adjusters after a loss when checking the adequacy of coverage per the coinsurance clause.

Adjuster Assignment Form - Fax

Generic fax form sent to an independent adjuster with details of a claim assignment. It allows for a full or limited assignment and lists specific actions required by the adjuster, such as loss verification, photos, scene diagram, statements, subrogation investigation, vehicle appraisals, and settlements.

Adjuster Preliminary Damage Assessment (FEMA Form 086-0-20, 4/14)

This form is used by adjusters to list potentially substantial danaged structures in preparation for possible ICC claims. NOTE: This form is currently under review at the Office of Management and Budget (OMB) and has expired effective April 30, 2017. However, OMB has authorized the continued use of the existing form, until the review process is complete. Upon OMB approval, FEMA will update this record with the new form.

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