Title Page
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House
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Location
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Conducted on
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Prepared by
Emergency Action Plan
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Water - Shut down instructions; Water Heater; Recirculation System; Instant Hot Water.
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Drain - Sewer or Septic
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Year Home was built
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Form to be signed in Successware.
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Years lived in the home.
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Years before planning to sale.
Essential Components
Water Pipes
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Main Shutoff location/type/size
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Main Shutoff is tagged.
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Main Shutoff
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Water Pressure
- 25-40
- 40-50
- 50-55
- 55-60
- 60-65
- 65-70
- 70-75
- 75-80
- 80-85
- 85-90
- 90-95
- 95-100
- 100-110
- 110-120
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Form to be signed in Successware.
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EPA article on Service Water Pressure
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Pressure Reducing Valve
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Type of Piping
- Pex
- Copper
- CPVC
- Steel
- Polybutylene
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Water Conditioning Equipment
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Location/Type
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Water Test
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Chlorine
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pH
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Hardness
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Does your family drink tap or bottled water?
Water Heater
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Location
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Water Heater
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Energy Source
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Sediment Trap
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Gas Shutoff
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Flue Piping
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Electrical Wiring
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Energy Pad
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Capacity(Gallons)
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Age
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If tank leaks would there be water damage?
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Temperature
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Manufacturer
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Model #
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Serial #
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Water Connections
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Shutoff Valve
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Temperature and Pressure Relief Valve
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Stand
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Earthquake Strapping
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Drain Pan
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Expansion Tank
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Recirculation System
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Last time it was flushed
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Emergency Shutdown Instructions
Drain/Vent Pipes
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Sewer Cleanout Location
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DrainVision
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Where was the piping accessed?
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Was video recorded and saved?
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Inside Drain Pipe Material
- ABS/PVC
- Steel
- Cast Iron
- Copper
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Proper Slope/Support
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Backwater Valve
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Location
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Condition
Pumps
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Sewage Ejection Pump
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Location/System
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Condition
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Sump Pump
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Location/System
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Condition
Laundry
Laundry
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Shutoffs/Arrestors
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Hoses
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Drain/Vent
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Laundry Sink
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Sink
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Sink Faucet
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Shutoffs/Supplies
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Sink Drain/Vent
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Dryer Vent
Kitchen
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Sink
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Faucet
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Hosespray
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Shutoffs/Supplies
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Drain/Vent System
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Dishwasher Shutoff/Supply
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Dishwasher Drain/Airgap
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Disposer
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InstaHot
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Icemaker shutoff/supply
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Filter
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Bar Sink
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Bar Sink
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Bar Sink Faucet
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Bar Sink Shutoffs/Supplies
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Bar Sink Drain
Bathrooms
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Main Bathroom
Bathroom
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Sink
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Sink Faucet
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Shutoffs/Supplies
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Sink Drain/Vent
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Toilet
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Fill Valve
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Flapper and Flush Valve
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Shutoff/Supply
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Seat
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Tub/Shower
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Caulking
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Tub/Shower Faucet
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Head/Arm/Flange
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Handshower
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Tub Spout
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Drain
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Waste/Overflow
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Primary Bathroom
Bathroom
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Sink
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Sink Faucet
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Shutoffs/Supplies
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Sink Drain/Vent
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Toilet
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Fill Valve
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Flapper
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Shutoff/Supply
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Seat
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Tub/Shower
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Caulking
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Tub/Shower Faucet
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Head/Arm/Flange
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Handshower
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Tub Spout
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Drain
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Waste/Overflow
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Sink Faucet
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Powder Bathroom
Bathroom
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Sink
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Sink Faucet
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Shutoffs/Supplies
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Sink Drain/Vent
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Toilet
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Fill Valve
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Flapper
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Shutoff/Supply
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Seat
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Tub/Shower
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Caulking
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Tub/Shower Faucet
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Head/Arm/Flange
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Handshower
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Tub Spout
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Drain
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Waste/Overflow
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Bathroom 4
Bathroom
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Sink
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Sink Faucet
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Shutoffs/Supplies
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Sink Drain/Vent
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Toilet
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Fill Valve
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Flapper
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Shutoff/Supply
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Seat
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Tub/Shower
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Caulking
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Tub/Shower Faucet
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Head/Arm/Flange
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Handshower
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Tub Spout
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Drain
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Waste/Overflow
Hose Faucets/Bibbs
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Frost Free Hose Faucets
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Locations
- Front
- Rear
- Left Side
- Right Side
- Garage
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Front Hose Faucet Condition
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Rear Hose Faucet Condtion
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Left Side Hose Faucet Condition
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Right Side Hose Faucet Condition
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Garage Hose Faucet Condition
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Hose Bibbs
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Locations
- Front
- Rear
- Left Side
- Right Side
- Garage
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Front Hose Bibb Condition
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Rear Hose Bibb Condition
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Left Side Hose Bibb Condition
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Right Side Hose Bibb Condition
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Garage Hose Bibb Condition
Crawlspace
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Crawlspace/Slab/Basement
- Crawlspace
- Slab
- Basement
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Access Location
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Condition
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Access Difficulty
Safety/Prevention
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CO2 Detectors
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Smoke Alarms
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Leak Protection
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Location/Type
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Monitoring/Sensors
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Location/Type
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WiFi
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Monitored Systems
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What/How monitored?
Signatures
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Technician
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Homeowner
