Insurance Scope & Documentation Template

Property owners, adjusters, and general contractors

Most dry ice line items get kicked back for the same three reasons: no measured quantity, no method justification, and no before/after photo tied to the area billed. This template is the checklist we use internally so a scope clears on first review.

980-355-2189

1. Loss identification

Claim number, date of loss, cause of loss, and carrier contact
Property address plus affected areas listed room by room or by grid zone
Category and class of loss (water) or damage classification (fire/smoke)
Photos of each affected area before any work begins, wide shot plus detail

2. Method justification

Substrate list: framing, sheathing, masonry, structural steel, ductwork, equipment
Why a dry method is required (no added moisture, non-conductive, no substrate loss, occupied adjacent spaces, historic substrate)
What the alternative would cost or damage (sanding, media blasting, wet cleaning, or tear-out and rebuild)
Reference to the applicable standard: IICRC S520 source removal or IICRC S700 fire and smoke practice

3. Measured quantities

Square footage of surface blasted, measured — not estimated by room size
Linear footage for joists, beams, and framing members where surface area differs
Containment square footage, negative-air unit count, and days deployed
HEPA vacuum labor hours and dry ice media consumed

4. Safety and controls

Containment plan and negative air pressure differential documented
CO2 monitoring records for the work zone (5,000 ppm TWA / 30,000 ppm STEL)
PPE and hearing protection noted; blast operations run at high dBA
Confined space or LOTO permits if applicable to the space or equipment

5. Verification and closeout

After photos from the same camera positions as the before photos
Third-party clearance testing results, if a mold claim
Written statement of what was removed versus what was recommended for demo
Blast settings log: pressure, media rate, and nozzle type per substrate

This template is provided as a general documentation aid. It is not legal, coverage, or claims advice, and it does not guarantee any carrier's approval of a scope. — REDI, Restoration & Environmental Dry Ice. 980-355-2189 · Sales@Redi-co.com · redi-co.com