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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 four key systems in a property: the roof, electrical, HVAC, and plumbing. This form must be completed by a licensed inspector in Florida and serves as a tool for insurance underwriting to evaluate a property's insurability. It is important to note that while the form provides detailed information about the property’s systems, it does not guarantee their longevity or suitability.

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Document Sample

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

Document Information

Fact Name	Description
Purpose	The 4-Point Inspection Form assesses the condition of four key systems: electrical, plumbing, HVAC, and roof. It helps insurance companies evaluate a property’s insurability.
State Requirement	In Florida, a licensed inspector must complete the form. This requirement is governed by Florida Statute 627.0627, which outlines the standards for property inspections.
Photo Documentation	Minimum photo requirements include images of the dwelling, roof slopes, plumbing, and the electrical panel. These photos support the findings of the inspection.
Inspector Credentials	Only Florida-licensed professionals, such as general contractors or home inspectors, can complete the form. Their signature certifies the accuracy of the inspection.
Condition Assessment	Each system is evaluated as either satisfactory or unsatisfactory. If a system is unsatisfactory, detailed explanations must be provided.
Hazard Identification	The form requires inspectors to note any hazards, such as exposed wiring or leaks. This information is crucial for underwriting decisions.
Updates and Renovations	Inspectors must document any updates or renovations, including dates and specifics. This helps assess the overall condition of the systems.
Agent Responsibilities	Insurance agents must review the 4-Point Inspection Form before submission. They are responsible for ensuring compliance with all requirements to avoid coverage issues.

4 Point Inspection - Usage Guidelines

Filling out the 4 Point Inspection form requires careful attention to detail. It is important to provide accurate information about the property and its systems. After completing the form, it will need to be signed by a Florida-licensed inspector. This ensures that all information is verified and trustworthy.

Start by entering the Insured/Applicant Name at the top of the form.
Fill in the Application/Policy # next to the name.
Provide the Address Inspected in the designated space.
Note the Actual Year Built of the property.
Enter the Date Inspected.
Ensure you meet the Minimum Photo Requirements listed in the form.
For the Electrical System, fill in the type and total amps for the main and second panels.
Indicate whether the amperage is sufficient for current usage and explain if it is not.
Check the presence of any specific wiring types and hazards.
Assess the general condition of the electrical system and provide comments if unsatisfactory.
For the HVAC System, indicate if central AC and heat are present.
Note the age of the system and any signs of blockage or leakage.
For the Plumbing System, check for a temperature pressure relief valve on the water heater.
Assess the condition of plumbing fixtures and connections, marking them as satisfactory or unsatisfactory.
For the Roof, provide details about the roof covering material, age, and condition.
Check for any visible signs of damage or leaks on the roof.
Complete the Additional Comments/Observations section if necessary.
Finally, ensure the form is signed, dated, and includes the inspector's title, license number, and company information.

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Dos and Don'ts

Do's:

Ensure the form is completed by a Florida-licensed inspector.
Provide accurate information about the insured/applicant and property details.
Attach required photos for each section as specified.
Clearly indicate any hazards or deficiencies found during the inspection.
Document the condition of each system in detail.

Don'ts:

Do not submit the form without the inspector's signature and date.
Avoid leaving any sections of the form blank.
Do not provide misleading or inaccurate information.
Refrain from using an unlicensed inspector to complete the form.
Do not ignore the minimum photo requirements for submission.

Common mistakes

Incomplete Information: Failing to fill out all required fields can lead to delays in processing. Ensure that every section is completed, including the insured/applicant name and address.
Missing Signatures: The form must be signed and dated by a licensed inspector. Omitting this crucial step can render the inspection invalid.
Insufficient Photos: Not providing the minimum required photos for each system can cause issues. Photos of the dwelling, roof, plumbing, and electrical panels are essential.
Incorrect Inspector Type: Submitting the form signed by an unlicensed inspector or a professional outside the required categories can lead to rejection. Only Florida-licensed professionals are acceptable.
Neglecting Hazards: Failing to document any hazards or deficiencies found during the inspection can mislead underwriting. It is vital to report all issues accurately.
Inaccurate System Condition: Misrepresenting the condition of the roof, electrical, HVAC, or plumbing systems can have serious repercussions. Each system should be assessed honestly.
Omitting Supplemental Information: Not providing additional details about updates or repairs can create confusion. This section should include any relevant observations.
Ignoring Age and Type of Systems: Failing to accurately report the age and type of systems can affect insurability. Be specific about what materials and systems are present.
Inconsistent Amperage Information: Providing conflicting information about the electrical system’s amperage can raise red flags. Ensure that all amperage details are clear and consistent.
Not Reviewing the Form: Skipping the review process before submission can lead to overlooked errors. Agents should double-check the form to ensure all requirements are met.

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