Plumbing Safety Checklist Form
Complete this checklist to assess plumbing safety and identify any hazards or maintenance needs.
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Full Name
*
First Name
Last Name
Location of Inspection
*
Are all shut-off valves clearly labeled and accessible?
*
Yes
No
N/A
Is all visible piping free from leaks, corrosion, or damage?
*
Yes
No
N/A
Are drain traps present and functioning under all sinks?
*
Yes
No
N/A
Are backflow prevention devices installed where required?
*
Yes
No
N/A
Plumbing System Safety Ratings
*
Rows
Excellent
Good
Fair
Poor
Water Heater Safety
1
2
3
4
Pipe Insulation Condition
5
6
7
8
Fixture Stability
9
10
11
12
Water Pressure Consistency
13
14
15
16
Are emergency procedures and contact information posted near main shut-off?
*
Yes
No
N/A
Additional Comments or Recommendations
Submit Inspection
Should be Empty: