• 4-Point Inspection Form

  • Date Inspected:
     - -
  • Rows

  • 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 (Type):
  • Is amperage sufficient for current usage?
  • Second Panel (Type):
  • Is amperage sufficient for current usage?
  • Indicate presence of any of the following:
  • Hazards Present
  • General condition of the electrical system:

  • Supplemental information

    Main Panel
  • Second Panel
  • Wiring Type

  • HVAC System

  • Central AC:
  • Central heat:
  • Are the heating, ventilation and air conditioning systems in good working order?

  • Hazards Present

  • Wood-burning stove or central gas fireplace not professionally installed?
  • Space heater used as primary heat source?
  • Is the source portable?
  • Does the air handler/condensate line or drain pan show any signs of blockage or leakage, including water damage to the surrounding area?

  • Supplemental Information

  • (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?
  • Is there any indication of an active leak?
  • Is there any indication of a prior leak?
  • Rows

  • Supplemental Information

  • Type of pipes (check all that apply)

  • Roof (With photos of each roof slope, this section can take the place of the Roof Inspection Form.)

  • Predominant Roof

  • If updated (check one):
  • Overall condition:
  • Any visible signs of damage / deterioration? (check all that apply and explain below)
  • Any visible signs of leaks?
  • Attic/underside of decking
  • Interior ceilings

  • Secondary Roof

  • If updated (check one):
  • Overall condition:
  • Any visible signs of damage / deterioration? (check all that apply and explain below)
  • Any visible signs of leaks?
  • Attic/underside of decking
  • Interior ceilings

  • 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.

  • Clear
  • Date
     - -

  • 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.

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