4-Point Inspection Form

A technical checklist a home inspector completes to record the condition of the roof, electrical panel, plumbing, and HVAC system ahead of an insurance policy decision.

Use this template

Page 1

Insured/Applicant Name:

Application / Policy #:

Address Inspected:

Actual Year Built:

Date Inspected:

Text

Main Panel (Type):

Circuit breaker Fuse box Unknown

Total Amps:

Is amperage sufficient for current usage?

Yes No

Explain

Second Panel (Type):

Circuit breaker Fuse box Not applicable

Total Amps:

Is amperage sufficient for current usage?

Yes No

Explain

Indicate presence of any of the following:

Hazards Present

Yes No

Double taps

Present Not present

Explain

General condition of the electrical system:

Excellent Good Fair Poor

Explain

Panel age:

Year last updated:

Brand/Model:

Panel age:

Year last updated:

Brand/Model:

Wiring Type

Copper Aluminum Knob-and-tube Unknown

Page 2

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:

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

Age of system:

Year last updated:

Text

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:

If unsatisfactory, please provide comments/details (leaks, wet/soft spots, mold, corrosion, grout/caulk, etc.).

Age of Piping System:

(Provide year and extent of renovation in the comments below)

Type of pipes (check all that apply)

(Specify)

Page 4

Text

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4-Point Inspection Form

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