Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • REPORT OVERVIEW

  • THE HOUSE IN PERSPECTIVE

  • Add media

  • CONVENTIONS USED IN THIS REPORT

  • SATISFACTORY

  • MARGINAL

  • POOR

  • MAJOR CONCERNS

  • SAFETY HAZARD

  • THE SCOPE OF THE PERSPECTIVE

  • BUILDING DATA

  • GROUNDS

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  • Service Walks

  • None

  • Not Visible

  • Material:

  • Concrete

  • Flagstone

  • Gravel

  • Brick

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Trip Hazard

  • Typical Cracks

  • Pitched towards home

  • Settling cracks

  • Public sidewalk need repair

  • Driveway/Parking

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  • None

  • Not Visible

  • Material:

  • Concrete

  • Asphalt

  • Gravel/Dirt

  • Brick

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Settling Cracks

  • Typical Cracks

  • Pitched towards home

  • Fill cracks and seal

  • Trip Hazard

  • Porch

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  • None

  • Not Visible

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Railing/Balusters recommended

  • Support Pier

  • Concrete

  • Wood

  • Floor

  • Satisfactory

  • Marginal

  • Poor

  • Safety Hazard

  • Stoops/Steps

  • Add media

  • None

  • Material:

  • Concrete

  • Wood

  • Railing/Balusters recommended

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Safety Hazard

  • Uneven Risers

  • Rotted/Damaged

  • Cracked

  • Settled

  • Patio

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  • None

  • Material:

  • Concrete

  • Flagstone

  • Kool-Deck

  • Brick

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Settling Cracks

  • Trip Hazard

  • Pitched towards home (see remarks)

  • Drainage provided

  • Typical cracks

  • Deck/Balcony

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  • None

  • Not Visible

  • Material:

  • Wood

  • Metal

  • Composite

  • Railing/Balusters recommended

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Wood in contact with soil

  • Finish

  • Treated

  • Painted/Stained

  • Safety Hazard

  • Improper attachment to house

  • Railing loose

  • Deck/Patio/Porch Covers

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  • None

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Posts/Supports need Repair

  • Earth to wood contact

  • Moisture/Insect damage

  • Recommend

  • Metal Straps/Bolts/Nails/Flashing

  • Improper attachment to house

  • Fence/Wall

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  • Not Evaluated

  • None

  • Type:

  • Brick

  • Block

  • Wood

  • Metal

  • Chain Link

  • Rusted

  • Vinyl

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Typical Cracks

  • Loose Blocks/Caps

  • Gate

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  • N/A

  • Satisfactory

  • Marginal

  • Poor

  • Planks missing/damaged

  • Operable?

  • Yes

  • No

  • Landscaping Affecting Foundation

  • N/A

  • Negative Grade

  • East

  • West

  • North

  • South

  • Satisfactory

  • Recommend additional backfill

  • Recommend window wells/covers

  • Trim back trees/shrubberies

  • Wood in contact with/improper clearance to soil

  • Retaining Wall

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  • None

  • Material

  • Brick

  • Concrete

  • Concrete block

  • Railroad ties

  • Timbers

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Safety Hazard

  • Leaning/cracked/ bowed

  • Drainage holes recommended

  • Hose Bibs

  • N/A

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • No anti-siphon valve

  • Recommend Anti-siphon valve

  • Operable

  • Yes

  • No

  • Not Tested

  • Not On

  • ROOF

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  • Roof Visibility

  • None

  • All

  • Partial

  • Inspected From

  • Roof

  • Ladder at eaves

  • Ground

  • With Binoculars

  • Style of Roof

  • Type

  • Gable

  • Hip

  • Mansard

  • Shed

  • Flat

  • Pitch

  • Low

  • Medium

  • Steep

  • Flat

  • Roof #1

  • Type:

  • Layers:

  • Age:

  • Location:

  • Roof #2

  • Type:

  • Layers:

  • Age:

  • Location:

  • Roof #3

  • Type:

  • Layers:

  • Age:

  • Location:

  • Ventilation System

  • Not Present

  • Type

  • Soffit

  • Ridge

  • Gable

  • Roof

  • Turbine

  • Powered

  • Flashing

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  • Material

  • Not Visible

  • Galv/Alum

  • Asphalt

  • Copper

  • Foam

  • Rubber

  • Lead

  • Condition

  • Not Visible

  • Satisfactory

  • Marginal

  • Poor

  • Rusted

  • Missing

  • Separated from chimney/roof

  • Recommended Sealing

  • Valleys

  • N/A

  • Material

  • Not Visible

  • Galv/Alum

  • Asphalt

  • Lead

  • Copper

  • Condition

  • Not Visible

  • Satisfactory

  • Marginal

  • Poor

  • Holes

  • Rusted

  • Recommend Sealing

  • Condition of Roof Coverings

  • Roof #1

  • Satisfactory

  • Marginal

  • Poor

  • Roof #2

  • Satisfactory

  • Marginal

  • Poor

  • Roof #3

  • Satisfactory

  • Marginal

  • Poor

  • Condition

  • Curling

  • Cracking

  • Ponding

  • Burn Spots

  • Broken/Loose Tiles/Shingles

  • Nail Popping

  • Granules Missing

  • Alligatoring

  • Blistering

  • Missing Tabs/Shingles/Tiles

  • Moss Buildup

  • Exposed Felt

  • Cupping

  • Incomplete/Improper Nailing

  • Recommend Roofer Evaluate

  • Evidence of Leakage

  • Skylights

  • N/A

  • Not Visible

  • Condition

  • Cracked/Broken

  • Satisfactory

  • Marginal

  • Poor

  • Plumbing Vents

  • Not Visible

  • Not Present

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • EXTERIOR

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  • Chimney(s)

  • None

  • Location(s):

  • Viewed From

  • Roof

  • Ladder at eaves

  • Ground (Inspection Limited)

  • With Binoculars

  • Rain Cap/Spark Arrestor

  • Yes

  • No

  • Recommended

  • Chase

  • Brick

  • Stone

  • Metal

  • Blocks

  • Framed

  • Evidence of

  • Holes in metal

  • Cracked chimney cap

  • Loose mortar joints

  • Flaking

  • Loose brick

  • Rust

  • Flue

  • Tile

  • Metal

  • Unlined

  • Not Visible

  • Evidence of

  • Scaling

  • Cracks

  • Creosote

  • Not evaluated

  • Have flue(s) cleaned and re-evaluated

  • Recommend Cricket/Saddle/Flashing

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend Repair

  • Gutters/Scuppers/Eavestrough

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  • None

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Rusting

  • Downspouts needed

  • Recommend repair/replace

  • Needs to be cleaned

  • Material

  • Copper

  • Vinyl/Plastic

  • Galvanized/Aluminum

  • Leaking

  • Corners

  • Joints

  • Hole in main run

  • Attachment

  • Loose

  • Missing spikes

  • Improperly slope

  • Extension Needed

  • North

  • South

  • East

  • West

  • Siding

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  • Material

  • Stone

  • Slate

  • Block/Brick

  • Fiberboard

  • Fiber-cement

  • Stucco

  • EIFS* Not Inspected

  • Asphalt

  • Wood

  • Metal/Vinyl

  • Typical cracks

  • Peeling paint

  • Monitor

  • Wood rot

  • Loose/Missing/Holes

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/painting

  • Trim

  • Material

  • Wood

  • Fiberboard

  • Aluminum/Steel

  • Vinyl

  • Stucco

  • Recommend repair/painting

  • Damaged wood

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Soffit

  • None

  • Material

  • Wood

  • Fiberboard

  • Aluminum/Steel

  • Vinyl

  • Stucco

  • Recommend repair/painting

  • Damaged wood

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Fascia

  • None

  • Material

  • Wood

  • Fiberboard

  • Aluminum/Steel

  • Vinyl

  • Stucco

  • Recommend repair/painting

  • Damaged wood

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Flashing

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  • None

  • Material

  • Wood

  • Fiberboard

  • Aluminum/Steel

  • Vinyl

  • Stucco

  • Recommend repair/painting

  • Damaged

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Caulking

  • Add media

  • None

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend around windows/masonry ledges/corners/utility penetrations

  • Windows/Screens

  • Add media

  • Condition

  • Satisfactory

  • Recommend repair/replace damaged screens

  • Failed/fogged insulated glass

  • Marginal

  • Poor

  • Wood rot

  • Recommend repair/painting

  • Material

  • Wood

  • Metal

  • Vinyl

  • Aluminum/Vinyl clad

  • Screens

  • Torn

  • Bent

  • Not installed

  • Storm Windows

  • Add media

  • None

  • Not installed

  • Condition:

  • Condition

  • Satisfactory

  • Broken/cracked

  • Wood rot

  • Recommend repair/painting

  • Material

  • Wood

  • Clad comb

  • Wood/metal comb

  • Metal

  • Putty

  • Satisfactory

  • Needed

  • N/A

  • Slab-On-Grade/Foundation

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  • Foundation Wall

  • Concrete block

  • Poured concrete

  • Post-Tensioned

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Monitor

  • Have Evaluated

  • Not Evaluated

  • Concrete Slab

  • N/A

  • Not Visible

  • Satisfactory

  • Marginal

  • Monitor

  • Have Evaluated

  • Service Entry

  • Underground

  • Overhead

  • Weather head/mast needs repair

  • Overhead wires to low

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Exterior Receptacles

  • Yes

  • No

  • Operable

  • Yes

  • No

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • GFCI present

  • Yes

  • No

  • Operable

  • Yes

  • No

  • Safety Hazard

  • Reverse polarity

  • Open ground(s)

  • Recommend GFCI Receptacles

  • Building(s) Exterior Wall Construction

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  • Type

  • Not Visible

  • Framed

  • Masonry

  • Condition

  • Not Visible

  • Satisfactory

  • Marginal

  • Poor

  • Exterior Doors

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  • Main Entrance

  • N/A

  • Weather Stripping

  • Satisfactory

  • Marginal

  • Poor

  • Missing

  • Replace

  • Door Condition

  • Satisfactory

  • Marginal

  • Poor

  • Patio

  • Add media

  • N/A

  • Weather stripping

  • Satisfactory

  • Marginal

  • Poor

  • Missing

  • Replace

  • Door Condition

  • Add media

  • Satisfactory

  • Marginal

  • Poor

  • Rear Door

  • Add media

  • N/A

  • Weather stripping

  • Satisfactory

  • Marginal

  • Poor

  • Missing

  • Replace

  • Door Condition

  • Satisfactory

  • Marginal

  • Poor

  • Other Door

  • N/A

  • Weather stripping

  • Satisfactory

  • Marginal

  • Poor

  • Missing

  • Replace

  • Door Condition

  • Satisfactory

  • Poor

  • Exterior A/C -Heatpump #1

  • Unit #1

  • N/A

  • Location:

  • Brand:

  • Model #:

  • Serial #:

  • Approximate Age:

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Cabinet/housing rusted

  • Energy Source

  • Electric

  • Gas

  • Unit Type

  • Air cooled

  • Water cooled

  • Geothermal

  • Heat pump

  • Outside Disconnect

  • Yes

  • No

  • Maximum fuse/breaker (amps)

  • Fuses/Breakers installed (amps)

  • Improperly sized fuses/breakers

  • Level

  • Yes

  • No

  • Recommend re-level unit

  • Condenser Fins

  • Damaged

  • Need cleaning

  • Damaged base/pad

  • Damaged Refrigerant Line

  • Improper Clearance (air flow)

  • Yes

  • No

  • Exterior A/C -Heatpump #1

  • Unit #1

  • N/A

  • Location:

  • Brand:

  • Model #:

  • Serial #:

  • Approximate Age:

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Cabinet/housing rusted

  • Energy Source

  • Electric

  • Gas

  • Unit Type

  • Air cooled

  • Water cooled

  • Geothermal

  • Heat pump

  • Outside Disconnect

  • Yes

  • No

  • Maximum fuse/breaker (amps)

  • Fuses/Breakers installed (amps)

  • Improperly sized fuses/breakers

  • Level

  • Yes

  • No

  • Recommend re-level unit

  • Condenser Fins

  • Damaged

  • Need cleaning

  • Damaged base/pad

  • Damaged Refrigerant Line

  • Improper Clearance (air flow)

  • Yes

  • No

  • GARAGE/CARPORT

  • None

  • Type

  • None

  • Attachment

  • Detached

  • 1-Car

  • 2-Car

  • 3-Car

  • 4-Car

  • Automatic Opener

  • Yes

  • No

  • Operable

  • Inoperable

  • Safety Reverse

  • Operable

  • Not Operable

  • Need(s) adjusting

  • Safety hazard

  • Photo eyes and pressure reverse tested

  • Roofing

  • Material

  • Same as house

  • Type:

  • Approx. age:

  • Approx. layers:

  • Gutters/Eavestrough

  • Add media

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Same as house

  • Siding

  • N/A

  • Material

  • Same as house

  • Wood

  • Metal

  • Vinyl

  • Stucco

  • Masonry

  • Slate

  • Fiberboard

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Recommend painting

  • Trim

  • N/A

  • Material

  • Same as house

  • Wood

  • Aluminum

  • Vinyl

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Recommend painting

  • Floor

  • Material

  • Concrete

  • Gravel

  • Asphalt

  • Dirt

  • Condition

  • Satisfactory

  • Typical cracks

  • Large settling cracks

  • Recommend evaluation/repair

  • Safety hazard

  • Burners less than 18" above floor

  • N/A

  • Yes

  • No

  • Sill Plates

  • Not Visible

  • Floor level

  • Elevated

  • Rotted/Damaged

  • Recommend repair

  • Overhead Door(s)

  • N/A

  • Material

  • Wood

  • Fiberglass

  • Masonite

  • Metal

  • Recommend repair

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Hardware loose

  • Safety Cable Recommended

  • Weatherstripping missing/damaged

  • Loose/missing

  • Recommend Priming/Painting Inside & Edges

  • Yes

  • No

  • Exterior Service Door

  • None

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Damage/Rusted

  • Electrical Receptacles

  • N/A

  • Not Visible

  • Reverse Polarity

  • Yes

  • No

  • Open Ground

  • Yes

  • No

  • Safety Hazard

  • GFCI Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Handyman/extension cord wiring

  • Recommend GFCI Receptacles

  • Fire Separation Walls & Ceiling

  • N/A

  • Present

  • Missing

  • Condition

  • Satisfactory

  • Recommend repair

  • Holes walls/ceiling

  • Safety hazard(s)

  • Moisture Stains Present

  • Yes

  • No

  • Typical Cracks

  • Yes

  • No

  • Fire door

  • Not verifiable

  • Not a fire door

  • Needs repair

  • Satisfactory

  • Auto Closure

  • N/A

  • Satisfactory

  • Inoperative

  • Missing

  • KITCHEN

  • Countertops

  • Satisfactory

  • Marginal

  • Recommend repair/caulking

  • Cabinets

  • Satisfactory

  • Marginal

  • Recommend repair/adjustment

  • Plumbing

  • Faucet Leaks

  • Yes

  • No

  • Pipes Leak/Corroded

  • Yes

  • No

  • Sink/Faucet

  • Satisfactory

  • Corroded

  • Chipped

  • Cracked

  • Recommend repair

  • Functional Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Functional Flow

  • Satisfactory

  • Marginal

  • Poor

  • Walls & Ceiling

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Moisture stains

  • Heating/Cooling Source

  • Yes

  • No

  • Floor

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Sloping

  • Squeaks

  • Appliances

  • Disposal

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Oven

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Range

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Dishwasher

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Trash Compactor

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Exhaust Fan

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Refrigerator

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Microwave

  • N/A

  • Not Tested

  • Operable:

  • Yes

  • No

  • Other

  • Operable:

  • Yes

  • No

  • Dishwasher Airgap

  • Yes

  • No

  • Dishwasher Drain Line Looped

  • Yes

  • No

  • Receptacles Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • GFCI

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Recommend GFCI Receptacles:

  • Yes

  • No

  • Potential Safety Hazard

  • LAUNDRY ROOM

  • Laundry

  • Laundry Sink

  • N/A

  • Faucet Leaks

  • Yes

  • No

  • Pipes Leak

  • Yes

  • No

  • Not Visible

  • Cross Connections

  • Yes

  • No

  • Potential Safety Hazard

  • Heat Source Present

  • Yes

  • No

  • Room Vented

  • Yes

  • No

  • Dryer Vented

  • N/A

  • Wall

  • Ceiling

  • Floor

  • Not vented

  • Plastic dryer vent not recommended

  • Not vented to exterior

  • Recommend repair

  • Safety hazard

  • Electrical

  • Open ground/reverse polarity:

  • Yes

  • No

  • Safety hazard

  • GFCI Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Recommend GFCI Receptacles

  • Appliances

  • Washer

  • Dryer

  • Water heater

  • Furnace/Boiler

  • Washer Hook-Up Lines/Valves

  • Satisfactory

  • Leaking

  • Corroded

  • Not Visible

  • Gas Shut-Off Valve

  • N/A

  • Yes

  • No

  • Cap Needed

  • Safety hazard

  • Not Visible

  • BATHROOM #1

  • Bath

  • Location

  • Sinks

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Tubs

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Showers

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Toilet

  • Bowl loose:

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Cracked bowl

  • Toilet leaks

  • Whirlpool

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Not tested

  • No access door

  • Shower/Tub area

  • Ceramic/Plastic

  • Fiberglass

  • Masonite

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Rooted floors

  • Caulk/Grouting needed:

  • Yes

  • No

  • Where:

  • Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Water Flow

  • Satisfactory

  • Marginal

  • Poor

  • Moisture Stains Present

  • Yes

  • No

  • Walls

  • Ceilings

  • Cabinetry

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Window

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Receptacles Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • GFCI

  • Yes

  • No

  • Recommend GFCI Operable:

  • Yes

  • No

  • Open Ground/Reverse Polarity

  • Yes

  • No

  • Potential Safety Hazard

  • Recommend GFCI Receptacles

  • Heat Source Present

  • Yes

  • No

  • Exhaust Fan

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Noisy

  • BATHROOM#2

  • Bath

  • Location

  • Sinks

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Tubs

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Showers

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Toilet

  • Bowl loose:

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Cracked bowl

  • Toilet leaks

  • Whirlpool

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Not tested

  • No access door

  • Shower/Tub area

  • Ceramic/Plastic

  • Fiberglass

  • Masonite

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Rooted floors

  • Caulk/Grouting needed:

  • Yes

  • No

  • Where:

  • Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Water Flow

  • Satisfactory

  • Marginal

  • Poor

  • Moisture Stains Present

  • Yes

  • No

  • Walls

  • Ceilings

  • Cabinetry

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Window

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Receptacles Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • GFCI

  • Yes

  • No

  • Recommend GFCI Operable:

  • Yes

  • No

  • Open Ground/Reverse Polarity

  • Yes

  • No

  • Potential Safety Hazard

  • Recommend GFCI Receptacles

  • Heat Source Present

  • Yes

  • No

  • Exhaust Fan

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Noisy

  • BATHROOM #3

  • Bath

  • Location

  • Sinks

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Tubs

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Showers

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Toilet

  • Bowl loose:

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Cracked bowl

  • Toilet leaks

  • Whirlpool

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Not tested

  • No access door

  • Shower/Tub area

  • Ceramic/Plastic

  • Fiberglass

  • Masonite

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Rooted floors

  • Caulk/Grouting needed:

  • Yes

  • No

  • Where:

  • Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Water Flow

  • Satisfactory

  • Marginal

  • Poor

  • Moisture Stains Present

  • Yes

  • No

  • Walls

  • Ceilings

  • Cabinetry

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Window

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Receptacles Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • GFCI

  • Yes

  • No

  • Recommend GFCI Operable:

  • Yes

  • No

  • Open Ground/Reverse Polarity

  • Yes

  • No

  • Potential Safety Hazard

  • Recommend GFCI Receptacles

  • Heat Source Present

  • Yes

  • No

  • Exhaust Fan

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Noisy

  • BATHROOM #4

  • Bath

  • Location

  • Sinks

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Tubs

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Showers

  • N/A

  • Faucet leaks:

  • Yes

  • No

  • Pipes leak:

  • Yes

  • No

  • Not Visible

  • Toilet

  • Bowl loose:

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Cracked bowl

  • Toilet leaks

  • Whirlpool

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Not tested

  • No access door

  • Shower/Tub area

  • Ceramic/Plastic

  • Fiberglass

  • Masonite

  • Condition:

  • Satisfactory

  • Marginal

  • Poor

  • Rooted floors

  • Caulk/Grouting needed:

  • Yes

  • No

  • Where:

  • Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Water Flow

  • Satisfactory

  • Marginal

  • Poor

  • Moisture Stains Present

  • Yes

  • No

  • Walls

  • Ceilings

  • Cabinetry

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Window

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Receptacles Present

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • GFCI

  • Yes

  • No

  • Recommend GFCI Operable:

  • Yes

  • No

  • Open Ground/Reverse Polarity

  • Yes

  • No

  • Potential Safety Hazard

  • Recommend GFCI Receptacles

  • Heat Source Present

  • Yes

  • No

  • Exhaust Fan

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Noisy

  • ROOM #1

  • Room

  • Location:

  • Type:

  • Unit #:

  • Walls & Ceiling

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Damage

  • Moisture Stains

  • Yes

  • No

  • Where:

  • Floor:

  • Satisfactory

  • Marginal

  • Poor

  • Squeaks

  • Slopes

  • Tripping Hazard

  • Ceiling Fan

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Electrical

  • Operable:

  • Yes

  • No

  • Switches:

  • Yes

  • No

  • Operable

  • Receptacles:

  • Yes

  • No

  • Operable

  • Open ground/reverse polarity:

  • Yes

  • No

  • Safety hazard

  • Cover plates missing

  • Heating Source Present

  • Yes

  • No

  • Holes:

  • Doors

  • Walls

  • Ceilings

  • Bedroom Egress Restricted

  • N/A

  • Yes

  • No

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • Windows

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • ROOM #2

  • Room

  • Location:

  • Type:

  • Unit #:

  • Walls & Ceiling

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Damage

  • Moisture Stains

  • Yes

  • No

  • Where:

  • Floor:

  • Satisfactory

  • Marginal

  • Poor

  • Squeaks

  • Slopes

  • Tripping Hazard

  • Ceiling Fan

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Electrical

  • Operable:

  • Yes

  • No

  • Switches:

  • Yes

  • No

  • Operable

  • Receptacles:

  • Yes

  • No

  • Operable

  • Open ground/reverse polarity:

  • Yes

  • No

  • Safety hazard

  • Cover plates missing

  • Heating Source Present

  • Yes

  • No

  • Holes:

  • Doors

  • Walls

  • Ceilings

  • Bedroom Egress Restricted

  • N/A

  • Yes

  • No

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • Windows

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • ROOM #3

  • Room

  • Location:

  • Type:

  • Unit #:

  • Walls & Ceiling

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Damage

  • Moisture Stains

  • Yes

  • No

  • Where:

  • Floor:

  • Satisfactory

  • Marginal

  • Poor

  • Squeaks

  • Slopes

  • Tripping Hazard

  • Ceiling Fan

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Electrical

  • Operable:

  • Yes

  • No

  • Switches:

  • Yes

  • No

  • Operable

  • Receptacles:

  • Yes

  • No

  • Operable

  • Open ground/reverse polarity:

  • Yes

  • No

  • Safety hazard

  • Cover plates missing

  • Heating Source Present

  • Yes

  • No

  • Holes:

  • Doors

  • Walls

  • Ceilings

  • Bedroom Egress Restricted

  • N/A

  • Yes

  • No

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • Windows

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • ROOM #4

  • Room

  • Location:

  • Type:

  • Unit #:

  • Walls & Ceiling

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Damage

  • Moisture Stains

  • Yes

  • No

  • Where:

  • Floor:

  • Satisfactory

  • Marginal

  • Poor

  • Squeaks

  • Slopes

  • Tripping Hazard

  • Ceiling Fan

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Recommend repair/replace

  • Electrical

  • Operable:

  • Yes

  • No

  • Switches:

  • Yes

  • No

  • Operable

  • Receptacles:

  • Yes

  • No

  • Operable

  • Open ground/reverse polarity:

  • Yes

  • No

  • Safety hazard

  • Cover plates missing

  • Heating Source Present

  • Yes

  • No

  • Holes:

  • Doors

  • Walls

  • Ceilings

  • Bedroom Egress Restricted

  • N/A

  • Yes

  • No

  • Doors

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

  • Windows

  • Satisfactory

  • Marginal

  • Poor

  • Cracked glass

  • Evidence of leaking insulated glass

  • Broken/Missing hardware

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.