Home Electrical Inspection Form
Inspection Company Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
House Owner's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
General Inspection
Rows
Checked
Not Checked
Need Repair
N/A
Outlets
1
2
3
4
Line Cords
5
6
7
8
Extension Cords
9
10
11
12
Plugs
13
14
15
16
Light Bulbs
17
18
19
20
Appliances
21
22
23
24
Entertainment/Computer Equipment
25
26
27
28
Outdoor Safety
29
30
31
32
Space Heaters
33
34
35
36
Halogen Floor Lamps
37
38
39
40
Ground Fault Circuit Interrupters (GFCIs)
Rows
Checked
Not Checked
Need Repair
N/A
Kitchen
41
42
43
44
Bathrooms
45
46
47
48
Garage
49
50
51
52
Laundry Room
53
54
55
56
Outdoors
57
58
59
60
Inspection Details
Inspection Score
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Inspector Name
First Name
Last Name
Inspector's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Inspector Signature
Submit
Should be Empty: