Four Point Inspection Form

Note: A Four-Point Insurance Inspection is a limited, visual survey of the heating and air conditioning, roof, electrical, and plumbing systems for insurance policy purposes. This is an example of a form that met (at one time) accepted underwriting requirements for four-point inspections in the State of Florida. This form is just an example, before using any form, please contact an underwriting supervisor for verfiication.

Date of inspection:

Property’s Address:

Property’s City, State, Zip Code:

Type of home:

Type of construction:

Type of foundation:

Number of stories:

Approximate square feet:

Approximate total living area:

Approximate age of home:

Client/owner’s name:

Insurance company/policy number:

Inspector’s name:

Inspector’s ID number:

Inspector’s signature:

Inspector’s company name:

Inspector’s address:

Inspector’s city, state, zip code:

Inspector’s email address:

Inspector’s phone number:

 

Heating/Air Conditioning

Types of heating systems:

Estimated age of heating systems:

Heating systems upgraded? Year?

Condition of heating systems:

Fuel Tank located?

Heating system comments:

Types of cooling systems:

Estimated age of cooling systems:

Cooling systems upgraded? Year?

Condition of cooling system:

Cooling system comments:

 

 

 

Plumbing

Number of bathrooms:

Overall water pressure:

Main supply line material:

Main waste/vent material:

Fixture supply line material:

Fixture drain line material:

Shut off valves present:

Water heater location?

Water heater fuel type?

Approximate age of water heater:

TPR valve present?

Fire sprinkler system present?

Freeze hazards noticed?

Polybutylene noticed?

Plumbing leaks noticed?

Recent plumbing upgrades? Year?

Overall plumbing condition:

Plumbing comments:

 

 

Roof

Roof style:

Type of roof covering:

Estimated age of roof covering

Number of shingle layers:

Type of sheathing:

Flashing damage noticed?

Missing shingles or covering?

Truss or rafter damage noticed?

Evidence of active leaks?

Estimated life expectancy:

Roof comments:

 

 

 

Electrical

Service amps:

Size of service sufficient?

Fuses or Circuit breakers?

Main panel location:

Panel ground observed?

GFCIs present where required?

AFCIs present in bedrooms?

Aluminum branch circuits?

Active knob and tube wiring?

Exposed or unsafe wiring noticed?

Recent upgrades? Year?

Overall electrical system condition:

Electrical comments:

 

 

Other Comments


Are there any deficiencies which need correction? If so, explain.

 

 

 

 

 

 

 

 

When will the deficiencies be corrected? Please provide an approximate date of completion.

Have all deficiencies been corrected? If so, when was this work completed?