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Free 4 Point Inspection Form

The 4 Point Inspection Form is a document used to assess the condition of a property's roof, electrical, HVAC, and plumbing systems. It helps determine the insurability of a property by providing essential information to underwriters. Completing this form accurately is important for homeowners and agents alike.

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Contents

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4-Point Inspection Form

Insured/Applicant Name:_________________________________________________ Application / Policy #:__________________________

Address Inspected:___________________________________________________________________________________________________

Actual Year Built:________________________		Date Inspected: ______________________________________________

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				Second Panel
Type:	Circuit breaker	Fuse		Type:	Circuit breaker Fuse
Total Amps: __________				Total Amps: __________
Is amperage sufficient for current usage?			Yes No (explain)	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			Double taps
Blowing fuses			Exposed wiring
Tripping breakers			Unsafe wiring
Empty sockets			Improper breaker size
Loose wiring			Scorching
Improper grounding			Other (explain)
Corrosion
Over fusing

General condition of the electrical system:	Satisfactory	Unsatisfactory (explain)

Supplemental information

Main Panel	Second Panel	Wiring Type
Panel age: __________	Panel age: __________	Copper
Year last updated: __________	Year last updated:__________	NM, BX or Conduit
Brand/Model: __________	Brand/Model: __________

Sample Form Insp4pt 01 18

4-Point Inspection Form

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		Satisfactory Unsatisfactory	N/A
Satisfactory Unsatisfactory		N/A		Satisfactory Unsatisfactory	N/A
Dishwasher				Toilets
Refrigerator				Sinks
Washing machine				Sump pump
Water heater				Main shut off valve
Showers/Tubs				All other visible

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

Supplemental Information

Age of Piping System:		Type of pipes (check all that apply)
_____	Original to home	Copper
		Copper
_____	Completely re-piped	PVC/CPVC
		PVC/CPVC
_____	Partially re-piped	Galvanized
		Galvanized
(Provide year and extent of renovation in the comments below)		PEX
		PEX
		Polybutylene
		Other (specify)

Sample Form Insp4pt 01 18

4-Point Inspection Form

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)

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

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

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

Sample Form Insp4pt 01 18

4-Point Inspection Form

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.

Sample Form Insp4pt 01 18

Common mistakes

Filling out the 4-Point Inspection form can be a straightforward task, but many people make common mistakes that can lead to complications later. Understanding these pitfalls is essential for ensuring a smooth process. Here are five mistakes often encountered.

One frequent error is incomplete information. Many applicants forget to fill in crucial details such as the insured/applicant name or the application/policy number. Missing this information can delay the underwriting process significantly. It is vital to double-check that all required fields are filled out accurately before submission.

Another common mistake involves the photo requirements. The form specifies that photos must be provided for each side of the dwelling, each slope of the roof, and various plumbing and electrical components. Failing to include these photos can lead to rejection of the form. Always ensure that the minimum photo requirements are met to avoid unnecessary setbacks.

People often overlook the importance of documenting hazards and deficiencies. If any issues are noted during the inspection, they must be clearly described in the comments section. Simply marking "satisfactory" without addressing visible problems can raise red flags during the underwriting process. Transparency is crucial; it helps in evaluating the property accurately.

Additionally, some individuals do not provide sufficient details about the systems inspected. For instance, if the electrical system shows signs of wear or if the HVAC system has not been serviced recently, these points need to be elaborated upon. Providing thorough explanations helps the underwriters make informed decisions regarding insurability.

Lastly, a significant mistake is the failure to ensure that the form is signed by a Florida-licensed inspector. The form must be completed, signed, and dated by a qualified professional. If this step is overlooked, the entire inspection may be deemed invalid. Always verify that the inspector's credentials are in order and that their signature is present before submitting the form.

By avoiding these common mistakes, applicants can help ensure a smoother inspection process and a better chance of securing coverage. Careful attention to detail is key.

Dos and Don'ts

Do ensure all required fields are completed accurately, including the insured/applicant name and address.
Do include clear photographs of each side of the dwelling, all roof slopes, and relevant plumbing and electrical components.
Do have the inspection form signed and dated by a Florida-licensed inspector.
Do document any hazards or deficiencies in detail, ensuring clarity for underwriting review.
Don't submit the form without verifying that all systems are in good working order.
Don't neglect to provide supplemental information for any systems that are not satisfactory.
Don't overlook the requirement for specific documentation for aluminum wiring remediation, if applicable.

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Similar forms

Home Inspection Report: Similar to the 4 Point Inspection form, a home inspection report evaluates the overall condition of a property. It covers various systems, including plumbing, electrical, and HVAC, providing a comprehensive overview for potential buyers or insurers.
Roof Inspection Report: This document focuses specifically on the roof's condition, detailing materials, age, and any visible damage. The 4 Point Inspection includes a roof section that assesses similar aspects, ensuring both documents provide insights into roofing issues.
Electrical Inspection Report: An electrical inspection report examines the safety and functionality of a property's electrical systems. The 4 Point Inspection form also assesses electrical components, noting any hazards or deficiencies, making both documents essential for safety evaluations.
Employee Handbook: To ensure a clear understanding of workplace policies, utilize the comprehensive Employee Handbook resources designed to support employees in navigating their rights and responsibilities.
HVAC Inspection Report: This report evaluates the heating, ventilation, and air conditioning systems in a property. The HVAC section of the 4 Point Inspection form serves a similar purpose, detailing the system's condition and any maintenance history.
Plumbing Inspection Report: A plumbing inspection report assesses the condition of a property's plumbing systems, including pipes and fixtures. The 4 Point Inspection form includes a plumbing section that addresses similar concerns, ensuring comprehensive coverage of plumbing issues.
Insurance Underwriting Inspection Report: This report is used by insurance companies to evaluate risk before issuing a policy. The 4 Point Inspection form is specifically designed for underwriting purposes, providing necessary information about the property's systems to assess insurability.
Property Condition Assessment (PCA): A PCA evaluates the physical condition of a property and identifies any needed repairs. Similar to the 4 Point Inspection, it provides a detailed analysis of various systems, helping stakeholders make informed decisions about property management or investment.

Free 4 Point Inspection Form

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Common mistakes

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