Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • INTERIOR

  • Fireplace

  • None

  • Location(s):

  • Type

  • Gas

  • Wood

  • Solid fuel burning stove

  • Electric

  • Ventless

  • Material

  • Masonry

  • Metal (pre-fabricated)

  • Metal insert

  • Cast Iron

  • Miscellaneous

  • Blower built-in

  • Operable:

  • Yes

  • No

  • Damper operable:

  • Yes

  • No

  • Open joints or cracks in firebrick/panels should be sealed

  • Fireplace doors need repair

  • Damper Modified for Gas Operation

  • N/A

  • Yes

  • No

  • Damper missing

  • Hearth Extension Adequate

  • Yes

  • No

  • Mantel

  • N/A

  • Secure

  • Loose

  • Recommend repair/replace

  • Physical Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend having flue cleaned and re-examined

  • Not evaluated

  • Stairs/Steps/Balconies

  • None

  • Satisfactory

  • Marginal

  • Poor

  • Loose/Missing

  • Handrail

  • Satisfactory

  • Marginal

  • Poor

  • Safety hazard

  • Hand Rail/Railing/Balusters recommended

  • Risers/Treads

  • Satisfactory

  • Marginal

  • Poor

  • Risers/Treads uneven

  • Trip hazard

  • Smoke/Carbon Monoxide Detectors

  • Present

  • Smoke detector

  • Operable:

  • Yes

  • No

  • Not tested

  • Recommend additional

  • CO Detector

  • Operable:

  • Yes

  • No

  • Not tested

  • Recommend additional

  • Attic/Structure/Framing/Insulation

  • N/A

  • Access

  • Stairs

  • Pulldown

  • Scuttlehole/Hatch

  • No Access

  • Inspected From

  • Access panel

  • In the attic

  • Other

  • Location

  • Hallway

  • Bedroom Closet

  • Garage

  • Other

  • Access Limited By:

  • Flooring

  • Complete

  • Partial

  • None

  • Insulation

  • Fiberglass

  • Batts

  • Loose

  • Cellulose

  • Foam

  • Other

  • Vermiculite

  • Rock Wool

  • Depth

  • Recommend baffles at eaves

  • Damaged

  • Displaced

  • Missing

  • Compressed

  • Installed In

  • Rafters/Trusses

  • Walls

  • Between ceiling joists

  • Underside of roof deck

  • Not Visible

  • Recommend additional ventilation

  • Vapor Barriers

  • Kraft/foiled faced

  • Plastic sheeting

  • Not Visible

  • Improperly installed

  • Ventilation

  • Ventilation appears adequate

  • Recommend additional ventilation

  • Fans Exhausted To

  • Attic:

  • Yes

  • No

  • Recommend repair

  • Outside:

  • Yes

  • No

  • Not Visible

  • HVAC Duct

  • N/A

  • Satisfactory

  • Damaged

  • Split

  • Disconnected

  • Leaking

  • Repair/Replace

  • Recommend Insulation

  • Chimney Chase

  • N/A

  • Satisfactory

  • Needs repair

  • Not Visible

  • Structural Problems Observed

  • Yes

  • No

  • Recommend repair

  • Recommend structural engineer

  • Roof Structure

  • Rafters

  • Trusses

  • Wood

  • Metal

  • Collar ties

  • Purlins

  • Knee wall

  • Not Visible

  • Ceiling Joists

  • Wood

  • Metal

  • Not Visible

  • Sheathing

  • Plywood

  • OSB

  • Planking

  • Rotted

  • Stained

  • Delaminated

  • Evidence of Condensation

  • Yes

  • No

  • Evidence of Moisture

  • Yes

  • No

  • Evidence of Leaking

  • Yes

  • No

  • Firewall Between Units

  • N/A

  • Yes

  • No

  • Needs repair/sealing

  • Electrical

  • Open junction box(es)

  • Handyman wiring

  • Visible knob-and-tube

  • BASEMENT

  • Stairs

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Typical wear and tear

  • Needs repair

  • Handrail

  • Yes

  • No

  • Condition

  • Satisfactory

  • Loose

  • Handrail/Railing/Balusters recommended

  • Headway Over Stairs

  • Satisfactory

  • Low clearance

  • Safety hazard

  • Foundation

  • Condition

  • Satisfactory

  • Marginal

  • Have evaluated

  • Monitor

  • Material

  • ICF

  • Brick

  • Concrete block

  • Fieldstone

  • Poured concrete

  • Horizontal Cracks

  • North

  • South

  • East

  • West

  • Step Cracks

  • North

  • South

  • East

  • West

  • Vertical Cracks

  • North

  • South

  • East

  • West

  • Covered Walls

  • North

  • South

  • East

  • West

  • Movement Apparent

  • North

  • South

  • East

  • West

  • Indication of Moisture

  • Yes

  • No

  • Fresh

  • Old stains

  • Walls

  • Floor

  • Material

  • Concrete

  • Dirt/Gravel

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Typical cracks

  • Not Visible

  • Seismic Bolts

  • N/A

  • None visible

  • Appear satisfactory

  • Recommend evaluation

  • Drainage

  • Sump Pump

  • Yes

  • No

  • Working

  • Not working

  • Needs cleaning

  • Pump not tested

  • Floor Drains

  • Yes

  • Not Visible

  • Drains not tested

  • Girders/Beams

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Stained/Rusted

  • Material

  • Steel

  • Wood

  • Concrete

  • LVL

  • Not Visible

  • Columns

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Stained/Rusted

  • Material

  • Steel

  • Wood

  • Concrete

  • Block

  • Not Visible

  • Joists

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Material

  • Wood

  • Steel

  • Truss

  • Not Visible

  • 2 x 8

  • 2 x 10

  • 2 x 12

  • Engineered I-Type

  • Sagging/altered joists

  • Subfloor

  • Not Visible

  • Indication of moisture stains/rotting

  • PLUMBING

  • Water Service

  • Main shut-off location:

  • Water Entry Piping

  • Not Visible

  • Copper/Galv.

  • PVC Plastic

  • CPVC Plastic

  • Polybutylene Plastic

  • PEX Plastic

  • Lead

  • Lead Other Than Solder Joints

  • Yes

  • No

  • Unknown

  • Service entry

  • Visible Water Distribution Piping

  • Copper

  • Galvanized

  • PVC Plastic

  • CPVC Plastic

  • Polybutylene Plastic

  • PEX Plastic

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Flow

  • Satisfactory

  • Marginal

  • Poor

  • Water pressure over 80 psi

  • Recommend plumber evaluate

  • Recommend pressure regulator box

  • Pipes Supply/Drain

  • Corroded

  • Leaking

  • Valves broken/missing

  • Dissimilar metal

  • Cross connection:

  • Yes

  • No

  • Safety hazard

  • Drain/Waste/Vent Pipe

  • Copper

  • Cast iron

  • Galvanized

  • PVC

  • ABS

  • Brass

  • Polyethylene

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Support/Insulation

  • N/A

  • Type:

  • Traps Proper P-Type

  • Yes

  • No

  • P-traps recommended

  • Drainage

  • Satisfactory

  • Marginal

  • Poor

  • Interior Fuel Storage System

  • N/A

  • Yes

  • No

  • Leaking:

  • Yes

  • No

  • Fuel Line

  • N/A

  • Copper

  • Brass

  • Black iron

  • Stainless steel

  • CSST

  • Not Visible

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend plumber evaluate

  • Main Fuel Shut-Off Location

  • N/A

  • Well Pump

  • N/A

  • Submersible

  • In basement

  • Well house

  • Well pit

  • Shared well

  • Pressure Gauge Operable

  • Yes

  • No

  • Not Visible

  • Sanitary/Grinder Pump

  • N/A

  • Sealed crock:

  • Yes

  • No

  • Check valve:

  • Yes

  • No

  • Shut-off valve:

  • Yes

  • No

  • Vented

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Water Heater #1

  • N/A

  • Brand Name:

  • Serial #:

  • Capacity:

  • Approx. age:

  • Type:

  • Gas

  • Electric

  • Oil

  • LP

  • Combustion Air Venting Present

  • Yes

  • No

  • N/A

  • Seismic Restraints Needed

  • Yes

  • No

  • N/A

  • Relief Valve

  • Yes

  • No

  • Extension proper:

  • Yes

  • No

  • Missing

  • Recommend repair

  • Improper material

  • Vent Pipe

  • N/A

  • Satisfactory

  • Pitch proper

  • Improper

  • Rusted

  • Recommend repair

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Water Heater #2

  • N/A

  • Brand Name:

  • Serial #:

  • Capacity:

  • Approx. age:

  • Type:

  • Gas

  • Electric

  • Oil

  • LP

  • Combustion Air Venting Present

  • Yes

  • No

  • N/A

  • Seismic Restraints Needed

  • Yes

  • No

  • N/A

  • Relief Valve

  • Yes

  • No

  • Extension proper:

  • Yes

  • No

  • Missing

  • Recommend repair

  • Improper material

  • Vent Pipe

  • N/A

  • Satisfactory

  • Pitch proper

  • Improper

  • Rusted

  • Recommend repair

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Water Softener

  • N/A

  • Present

  • Loop Installed

  • Yes

  • No

  • Plumbing Hooked Up

  • Yes

  • No

  • Plumbing Leaking

  • Yes

  • No

  • HEATING SYSTEM

  • Heating System

  • Unit #1

  • Brand name:

  • Approx. age:

  • Unknown

  • Model #:

  • Serial #:

  • Unit #2

  • Brand name:

  • Approx. age:

  • Unknown

  • Model #:

  • Serial #:

  • Energy Source

  • Gas

  • LP

  • Oil

  • Electric

  • Solid fuel

  • Warm Air System

  • Belt drive

  • Direct drive

  • Gravity

  • Central system

  • Floor/wall unit

  • Heat Exchanger

  • N/A

  • Sealed

  • Not visible

  • Visual w/mirror

  • Flame distortion

  • Rusted

  • Carbon/soot buildup

  • Carbon Monoxide

  • N/A

  • Detected at plenum

  • Detected at register

  • Not tested

  • CO Test

  • Tester:

  • Combustion Air Venting Present

  • N/A

  • Yes

  • No

  • Controls

  • Disconnect:

  • Yes

  • No

  • Normal operating and safety controls observed

  • Distribution

  • Metal duct

  • Insulated flex duct

  • Cold air returns

  • Duct board

  • Asbestos-like wrap

  • Safety hazard

  • Flue Piping

  • N/A

  • Satisfactory

  • Rusted

  • Improper slope

  • Safety hazard

  • Recommend repair/replace

  • Filter

  • Standard

  • Electrostatic

  • Satisfactory

  • Needs cleaning/replacement

  • Missing

  • Electronic (not tested)

  • When Turned On By Thermostat

  • Fired

  • Did not fire

  • Proper operation:

  • Yes

  • No

  • Not tested

  • Heat Pump

  • N/A

  • Supplement electric

  • Supplemental gas

  • Sub-Slab Ducts

  • N/A

  • Satisfactory

  • Marginal

  • Poor

  • Water/Sand Observed:

  • Yes

  • No

  • #1 - System Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommended HVAC technician examine

  • #2 - System Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommended HVAC technician examine

  • System Not Operated Due To

  • Exterior temperature

  • Boiler System

  • N/A

  • Brand name:

  • Approx. age:

  • Model #:

  • Serial #:

  • Energy Source:

  • Gas

  • LP

  • Oil

  • Electric

  • Solid fuel

  • Distribution

  • Hot water

  • Baseboard

  • Steam

  • Radiator

  • Radiant floor

  • Circulator

  • Pump

  • Gravity

  • Multiple zones

  • Controls

  • Temp/Pressure gauge exist:

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Oil Fired Units

  • Disconnect:

  • Yes

  • No

  • Combustion Air Venting Present

  • Yes

  • No

  • N/A

  • Relief Valve

  • Yes

  • No

  • Missing

  • Extension proper:

  • Yes

  • No

  • Recommend repair/replace

  • Operated

  • When turned on by thermostat:

  • Fired

  • Did not fire

  • Operation:

  • Satisfactory:

  • Yes

  • No

  • Recommend HVAC technician examine before closing

  • Other Systems

  • N/A

  • Electric baseboard

  • Radiant ceiling cable

  • Gas space heater

  • Solid fuel burning stove

  • Proper Operation:

  • Yes

  • No

  • System Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend HVAC technician examine

  • ELECTRIC/COOLING SYSTEM

  • Main Panel

  • Location:

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Adequate Clearance to Panel

  • Yes

  • No

  • Amperage/Voltage

  • Unknown

  • 60a

  • 100a

  • 150a

  • 200a

  • 400a

  • 120v/240v

  • Breakers/Fuses

  • Breakers

  • Fuses

  • Appears Grounded

  • Yes

  • No

  • Not Visible

  • GFCI Breaker

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • AFCI

  • Yes

  • No

  • Operable:

  • Yes

  • No

  • Main Wire

  • Copper

  • Aluminum

  • Solid Branch Aluminum Wiring

  • Not visible

  • Safety Hazard

  • Branch Wire Condition

  • Satisfactory

  • Poor

  • Recommend electrician evaluate/repair

  • Romex

  • BX cable

  • Conduit

  • Knob/Tube

  • Double tapping

  • Wire undersized/oversized breaker/fuse

  • Panel not accessible

  • Not evaluated

  • Reason:

  • Sub Panel(s)

  • None apparent

  • Location 1:

  • Location 2:

  • Locations 3:

  • Panel not accessible

  • Not evaluated

  • Reason:

  • Branch Wire

  • Copper

  • Aluminum

  • Safety hazard

  • Neutral/ground separated:

  • Yes

  • No

  • Neutral isolated:

  • Yes

  • No

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend separating/isolating neutrals

  • Recommend electrician repair/evaluate box

  • Heat Pump - A/C Unit #1

  • Central system

  • Wall unit

  • Brand name:

  • Location:

  • Age:

  • Serial #:

  • Evaporator Coil

  • Satisfactory

  • Not visible

  • Needs cleaning

  • Damaged

  • Refrigerant Lines

  • Leak/Oil present

  • Damage

  • Insulation missing

  • Satisfactory

  • Condensate Line/Drain

  • To exterior

  • To pump

  • Floor drain

  • Secondary Condensate Line/Drain

  • Present:

  • Yes

  • No

  • Needed:

  • Yes

  • No

  • Primary pan appears clogged

  • Recommend technician evaluate

  • Operational

  • Differential

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend HVAC technician examine/clean/service

  • Not operated due to exterior temperature

  • Heat Pump - A/C Unit #2

  • Central system

  • Wall unit

  • Brand name:

  • Location:

  • Age:

  • Serial #:

  • Evaporator Coil

  • Satisfactory

  • Not visible

  • Needs cleaning

  • Damaged

  • Refrigerant Lines

  • Leak/Oil present

  • Damage

  • Insulation missing

  • Satisfactory

  • Condensate Line/Drain

  • To exterior

  • To pump

  • Floor drain

  • Secondary Condensate Line/Drain

  • Present:

  • Yes

  • No

  • Needed:

  • Yes

  • No

  • Primary pan appears clogged

  • Recommend technician evaluate

  • Operational

  • Differential

  • Condition

  • Satisfactory

  • Marginal

  • Poor

  • Recommend HVAC technician examine/clean/service

  • Not operated due to exterior temperature

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