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Fill in a Valid 4 Point Inspection Form

The 4 Point Inspection Form is a crucial document used to assess the condition of a property's essential systems: the roof, electrical, HVAC, and plumbing. This inspection is typically required by insurance companies to evaluate a property's insurability. By providing detailed information about each system, homeowners can ensure they meet underwriting requirements and avoid potential issues when applying for coverage.

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Common PDF Templates

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Example - 4 Point Inspection Form

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

Documents used along the form

The 4-Point Inspection form is a crucial document in the insurance underwriting process, particularly for older homes. Alongside this form, several other documents and forms may be required to provide a comprehensive assessment of a property’s condition. Below is a list of commonly used forms that complement the 4-Point Inspection form.

Roof Inspection Form: This form focuses specifically on the condition of the roof. It details materials, age, and any visible damage or leaks, providing an in-depth look that may not be fully captured in the 4-Point Inspection.
HVAC Service Record: This document outlines the maintenance history of the heating, ventilation, and air conditioning systems. It includes dates of service, types of repairs, and any parts replaced, which helps assess system reliability.
Boat Bill of Sale: Essential for documenting the sale and transfer of ownership of a boat in California. Completing this form is important for both parties involved. For more information, visit https://pdfdocshub.com.
Plumbing Inspection Report: A dedicated plumbing inspection report provides details on the condition of pipes, fixtures, and connections. It highlights any leaks or potential issues that may not be fully addressed in the 4-Point Inspection.
Electrical Inspection Report: This report offers a thorough examination of the electrical system, including wiring, panels, and any hazards present. It serves to confirm the safety and functionality of the electrical components.
General Home Inspection Report: A general home inspection report covers a wide range of property aspects, from structural integrity to overall safety. It may include findings relevant to the 4-Point Inspection but provides a broader context.
Insurance Application Form: This form collects essential information about the property and the applicant. It is a prerequisite for initiating the underwriting process and must be completed accurately.
Disclosure Statement: This document outlines any known issues or repairs made to the property by the seller. It is important for underwriting as it provides transparency regarding the property's condition.
Photos of Property: Visual documentation is often required to support the findings in the inspection forms. Photos should include various angles of the dwelling, roof slopes, and any noted deficiencies.
Contractor Estimates: If repairs are needed, estimates from licensed contractors may be required. These documents provide cost assessments for necessary repairs and improvements.

Each of these documents plays a significant role in the underwriting process, ensuring that all aspects of the property are thoroughly evaluated. Proper documentation aids in making informed decisions regarding insurability and helps protect both the insurer and the insured.