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Blank 4 Point Inspection Form

The 4-Point Inspection Form is a crucial document used to assess the condition of a property's roof, electrical, HVAC, and plumbing systems. It must be completed by a licensed inspector in Florida and includes specific requirements for documentation and photographs. Ensuring all systems are functioning properly is essential for determining insurability.

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Table of Contents

When it comes to ensuring the safety and insurability of a property, the 4 Point Inspection form plays a crucial role. This form evaluates four key systems: the roof, electrical, HVAC, and plumbing. Each section requires detailed documentation, including the age of the systems, their current condition, and any visible hazards. For instance, the roof section assesses materials, age, and signs of deterioration, while the electrical section looks at wiring types and potential safety issues. The HVAC system evaluation checks for functionality and any signs of past issues, and the plumbing section ensures that all fixtures are operational and leak-free. To make the inspection thorough, licensed professionals must include photographs of the property and provide a signature certifying the accuracy of their findings. This structured approach not only helps in assessing the property’s condition but also aids insurance underwriters in determining coverage eligibility.

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Dos and Don'ts

When filling out the 4 Point Inspection form, it's crucial to follow specific guidelines to ensure accuracy and compliance. Here are six things you should and shouldn't do:

Do provide complete information for the insured/applicant name, application/policy number, and address inspected.
Do include all required photos of the dwelling, roof, plumbing, and electrical systems.
Do ensure that a Florida-licensed inspector signs and dates the form.
Do describe any hazards or deficiencies clearly in the comments section.
Don't omit any details about the systems' conditions, especially if they are unsatisfactory.
Don't submit the form without reviewing it for completeness and accuracy.

4 Point Inspection 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

Listed Questions and Answers

What is a 4-Point Inspection Form?

A 4-Point Inspection Form is a detailed document used primarily for insurance purposes. It evaluates the condition of four critical systems in a home: the electrical system, plumbing system, HVAC (heating, ventilation, and air conditioning) system, and the roof. This form helps insurance companies assess the insurability of a property.
Who is qualified to complete the 4-Point Inspection Form?

Only a Florida-licensed inspector can complete, sign, and date this form. Acceptable professionals include general contractors, building code inspectors, and home inspectors. Each professional must be licensed in Florida and capable of certifying the condition of the systems they inspect.
What are the minimum photo requirements for the inspection?

The inspection must include photographs of each side of the dwelling, each slope of the roof, and various plumbing components such as the water heater and exposed valves. Additionally, the main electrical panel must be photographed with the interior door labeled, and the electrical box should be shown with the panel removed. All noted hazards or deficiencies must also be documented with photos.
Why is a 4-Point Inspection Form necessary for insurance?

This form provides insurers with essential information to determine the insurability of a property. It highlights the condition of vital systems and identifies any potential hazards. Insurers rely on this data to make informed decisions regarding coverage and to assess risk levels associated with insuring the property.
What happens if the inspection reveals deficiencies?

If the 4-Point Inspection identifies deficiencies in any of the systems, the property may be deemed unsatisfactory for insurance coverage. The insurer may require repairs or upgrades to be completed before coverage can be bound. In some cases, properties with significant issues may be uninsurable until those problems are resolved.
Can I use a different inspection form?

While this specific 4-Point Inspection Form is not mandatory, any alternative inspection report submitted must contain at least the same level of detail. It is crucial that the information provided is comprehensive enough for underwriting purposes.
What should I do if my property has aluminum wiring?

If aluminum wiring is present, separate documentation of any remediation must be provided and certified by a licensed electrician. This includes detailing the type of remediation performed, such as COPALUM crimp connections or AlumiConn connections. This documentation is essential for the insurer's assessment.
What if my HVAC system is not central?

If your home does not have a central HVAC system, you should indicate the primary heat source and fuel type on the form. It is important to provide details about the condition of any alternative heating systems, as this information is crucial for the insurance evaluation.
What does "acceptable condition" mean on the form?

Acceptable condition indicates that each inspected system is functioning as intended without visible hazards or deficiencies. A Florida-licensed inspector must certify that the roof, electrical, HVAC, and plumbing systems meet these standards.
What should I do if I have additional comments or observations?

If there are any updates, visible hazards, or deficiencies noted during the inspection, the inspector should provide detailed comments in the designated section of the form. This information helps ensure that all relevant issues are documented for the insurer's review.

Form Overview

Fact Name	Description
Purpose	The 4-Point Inspection Form evaluates the condition of the roof, electrical, HVAC, and plumbing systems of a property.
Photo Requirements	Photos of each side of the dwelling, each slope of the roof, and key plumbing and electrical components must be included.
Inspector Credentials	A Florida-licensed inspector must complete, sign, and date the form. This ensures the inspection meets state standards.
Insurability Use	Underwriting uses the information from this form to determine the insurability of the property, but it does not guarantee system performance.
Electrical System Documentation	If aluminum wiring is present, separate documentation of remediation must be certified by a licensed electrician.
State-Specific Law	In Florida, the use of this form is governed by state insurance regulations, requiring licensed professionals for inspections.