Fillable 4-Point Inspection Form

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4-Point Inspection Form

On average this form takes 26 minutes to complete

The 4-Point Inspection Form form is 3 pages long and contains:

  • 1 signature
  • 126 check-boxes
  • 42 other fields

Country of origin: OTHERS
File type: PDF

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4-Point Inspection Form
Sample Form Insp4pt 01 18
Insured/Applicant Name:_________________________________________________ Application / Policy #:__________________________
Address Inspected:___________________________________________________________________________________________________
Actual Year Built:________________________ Date Inspected: ÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁÁ
Minimum Photo Requirements:
Dwelling: Each side Roof: Each slope Plumbing: Water heater, under cabinet plumbing/drains, exposed valves
Main electrical service panel with interior door label
Electrical box with panel off
All hazards or deficiencies noted in this report
A Florida-licensed inspector must complete, sign and date this form.
Be advised that Underwriting will rely on the information in this sample form, or a similar form, that is obtained from the Florida
licensed professional of your choice. This information only is used to determine insurability and is not a warranty or assurance of the
suitability, fitness or longevity of any of the systems inspected.
Electrical System
Separate documentation of any aluminum wiring remediation must be provided and certified by a licensed electrician.
Main Panel
Type: Circuit breaker Fuse
Total Amps: __________
Is amperage sufficient for current usage? Yes No (explain)
Second Panel
Type: Circuit breaker Fuse
Total Amps: __________
Is amperage sufficient for current usage? Yes No (explain)
Indicate presence of any of the following:
Cloth wiring
Active knob and tube
Branch circuit aluminum wiring (If present, describe the usage of all aluminum wiring):
* If single strand (aluminum branch) wiring, provide details of all remediation. Separate documentation of all work must be provided.
Connections repaired via COPALUM crimp
Connections repaired via AlumiConn
Hazards Present
Blowing fuses
Tripping breakers
Empty sockets
Loose wiring
Improper grounding
Corrosion
Over fusing
Double taps
Exposed wiring
Unsafe wiring
Improper breaker size
Scorching
Other (explain)
General condition of the electrical system: Satisfactory Unsatisfactory (explain)
Supplemental information
Main Panel
Panel age: __________
Year last updated: __________
Brand/Model: __________
Second Panel
Panel age: __________
Year last updated:__________
Brand/Model: __________
Wiring Type
Copper
MN, BX or Conduit
4-Point Inspection Form
Sample Form Insp4pt 01 18
HVAC System
Central AC: Yes No
Central heat: Yes No
If not central heat, indicate primary heat source and fuel type: _________________________________
Are the heating, ventilation and air conditioning systems in good working order? Yes No (explain)
Date of last HVAC servicing/inspection: ______________
Hazards Present
Wood-burning stove or central gas fireplace not professionally installed? Yes No
Space heater used as primary heat source? Yes No
Is the source portable? Yes No
Does the air handler/condensate line or drain pan show any signs of blockage or leakage, including water damage to the surrounding area?
Yes No
Supplemental Information
Age of system: _____________
Year last updated: _____________
(Please attach photo(s) of HVAC equipment, including dated manufacturer’s plate)
Plumbing System
Is there a temperature pressure relief valve on the water heater? Yes No
Is there any indication of an active leak? Yes No
Is there any indication of a prior leak? Yes No
Water heater location: _______________________________________________
General condition of the following plumbing fixtures and connections to appliances:
Satisfactory Unsatisfactory N/A
Dishwasher
Refrigerator
Washing machine
Water heater
Showers/Tubs
Satisfactory Unsatisfactory N/A
Toilets
Sinks
Sump pump
Main shut off valve
All other visible
If unsatisfactory, please provide comments/details (leaks, wet/soft spots, mold, corrosion, grout/caulk, etc.).
Supplemental Information
Age of Piping System:
_____ Original to home
_____ Completely re-piped
_____ Partially re-piped
(Provide year and extent of renovation in the comments below)
Type of pipes (check all that apply)
Copper
PVC/CPVC
Galvanized
PEX
Polybutylene
Other (specify)
4-Point Inspection Form
Sample Form Insp4pt 01 18
Roof (With photos of each roof slope, this section can take the place of the Roof Inspection Form.)
Predominant Roof
Covering material: __________
Roof age (years): __________
Remaining useful life (years): __________
Date of last roofing permit: __________
Date of last update: __________
If updated (check one):
Full replacement
Partial replacement
% of replacement: __________
Overall condition:
Satisfactory
Unsatisfactory (explain below)
Secondary Roof
Covering material: __________
Roof age (years): __________
Remaining useful life (years): __________
Date of last roofing permit: __________
Date of last update: __________
If updated (check one):
Full replacement
Partial replacement
% of replacement: __________
Overall condition:
Satisfactory
Unsatisfactory (explain below)
Any visible signs of damage / deterioration?
(check all that apply and explain below)
Cracking
Cupping/curling
Excessive granule loss
Exposed asphalt
Exposed felt
Missing/loose/cracked tabs or tiles
Soft spots in decking
Visible hail damage
Any visible signs of leaks? Yes No
Attic/underside of decking Yes No
Interior ceilings Yes No
Any visible signs of damage / deterioration?
(check all that apply and explain below)
Cracking
Cupping/curling
Excessive granule loss
Exposed asphalt
Exposed felt
Missing/loose/cracked tabs or tiles
Soft spots in decking
Visible hail damage
Any visible signs of leaks? Yes No
Attic/underside of decking Yes No
Interior ceilings Yes No
Additional Comments/Observations (use additional pages if needed):
All 4-Point Inspection Forms must be completed and signed by a verifiable Florida-licensed inspector.
I certify that the above statements are true and correct.
Inspector Signature Title License Number Date
Company Name License Type Work Phone
click to sign
signature
click to edit
4-Point Inspection Form
Sample Form Insp4pt 01 18
Special Instructions: This sample 4-Point Inspection Form includes the minimum data needed for Underwriting to
properly evaluate a property application. While this specific form is not required, any other inspection report submitted
for consideration must include at least this level of detail to be acceptable.
Photo Requirements
Photos must accompany each 4-Point Inspection Form. The minimum photo requirements include:
Dwelling: Each side
Roof: Each slope
Plumbing: Water heater, under cabinet plumbing/drains, exposed valves
Open main electrical panel and interior door
Electrical box with the panel off
All hazards or deficiencies
Inspector Requirements
To be accepted, all inspection forms must be completed, signed and dated by a verifiable Florida-licensed professional. Examples
include:
A general, residential, or building contractor
A building code inspector
A home inspector
Note: A trade-specific, licensed professional may sign off only on the inspection form section for their trade. (e.g., an electrician may
sign off only on the electrical section of the form.)
Documenting the Condition of Each System
The Florida-licensed inspector is required to certify the condition of the roof, electrical, HVAC and plumbing systems. Acceptable
Condition means that each system is working as intended and there are no visible hazards or deficiencies.
Additional Comments or Observations
This section of the 4-Point Inspection Form must be completed with full details/descriptions if any of the following are noted on the
inspection:
Updates: Identify the types of updates, dates completed and by whom
Any visible hazards or deficiencies
Any system determined not to be in good working order
Note to All Agents
The writing agent must review each 4-Point Inspection Form before it is submitted with an application for coverage. It is the agent’s
responsibility to ensure that all rules and requirements are met before the application is bound. Agents may not submit applications
for properties with electrical, heating or plumbing systems not in good working order or with existing hazards/deficiencies.
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4-Point Inspection Form

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Completed 17 April 2022

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