Insurance Inspection Records

INSURANCE INSPECTION RECORDS

Insured / Applicant Information

Date of Birth:    Phone:    Email:

Inspector Information & Inspection Details

Company:    License / ID:    Phone:

Inspection Date:    Time of Inspection:

Property / Item Inspected

Location on Premises:

Property Type:    Occupancy:

Year Built:    Construction Type:    Area (sq ft):

Number of Floors:

Policy Details & Coverage

Policy Type (check applicable):
Homeowners Commercial Property Dwelling Fire Other (specify):

Policy Period Start:    Policy Period End:

Inspection Findings — Condition Ratings

For each item below provide observed condition (Good / Fair / Poor) and brief notes.

Observed Hazards, Deficiencies, and Comments

Photographs & Documentation Checklist

Photographs attached Site diagrams/sketches attached Relevant permits provided Repair receipts or invoices provided

Recommendations & Required Corrections

Compliance Deadline (if required):

Exclusions, Limitations, and Reliance

This inspection is limited to visible, readily accessible components and is non‑invasive. Unless explicitly stated otherwise in writing, the inspector does not perform destructive testing, opening of finished surfaces, or specialized laboratory analysis. The following exclusions apply (check all applicable):

Pre-existing conditions not observable without demolition Normal wear and tear or gradual deterioration Concealed or latent defects Environmental hazards (mold, asbestos, lead) unless specifically tested Damage resulting from intentional acts, fraud, or arson

The inspector's statements are provided to the policyholder and insurer for underwriting and risk assessment purposes. The insurer, its representatives, and the policyholder may rely on the facts and observations recorded herein. The inspector and inspection company are not guarantors of future performance. Misrepresentation or omission of material information by the insured may form grounds for denial of coverage and rescission of the policy in accordance with the terms of the insurance contract.

Certification by Inspector and Insured Acknowledgment

Inspector certification: I certify that the inspection described in this record was performed by me or under my direct supervision. The statements contained herein are true and accurate to the best of my knowledge and represent the conditions observed on the date of inspection.

Insured acknowledgment: By signing below the insured acknowledges receipt of a copy of this inspection record, confirms that the information provided in this form is accurate and complete, and understands the limitations and exclusions set forth above. Failure to disclose material information may affect coverage.

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