Water Leak Inspection Checklist
Officer Name
First Name
Last Name
Plumber Name
First Name
Last Name
Site
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Description of Work
Cause of Leak
Property Assessment
Rows
Yes
No
Notes
There is no indication of stagnant water present.
1
2
There are no signs of leaks or stains from septic tanks or leech fields, floors, walls, or ceilings.
3
4
There are no notable cracks in the walls or ceilings.
5
6
Upon inspection of the visible pipes, there is no damage, evidence of leaks, or stains on the surrounding materials.
7
8
Drain pipes are angled slightly downwards towards the outlet leading to the septic or sewage system.
9
10
The water pump does not have a short cycle, and water flow is not restricted by galvanized pipes.
11
12
Specify the Areas of Concern
Please provide a photo document that illustrates the work required, if applicable?
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Recommendations
Estimated Date To Finish The Work Required
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Officer
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Plumber
Submit
Should be Empty: