SAM Evaluation Form – SAM by Mosby Building Arts

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SAM Evaluation and Check-Up Form

Project ID

Address

City

State

Zip

Client Name

Type of Evaluation

EvaluationGreen Check-UpBlue Check-Up SummerBlue Check-Up WinterGold Check-Up SpringGold Check-Up SummerGold Check-Up FallGold Check-Up Winter

Exterior Grade(Required)

N/A

Green

Yellow

Red

Exterior Grade Notes

Identify if soil slopes away from the home or if managed by swales etc.

Exterior Grade Image

Exterior Grade zx

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Max. file size: 50 MB.

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Driveway/Sidewalks(Required)

N/A

Green

Yellow

Red

Driveway/Sidewalks Notes

Check joints and cracks for proper sealant general condition of surface and uneven joints.

Driveway/Sidewalks Image

Driveway/Sidewalks zx

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Max. file size: 50 MB.

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Gutters(Required)

N/A

Green

Yellow

Red

Gutters Notes

Check gutters for functionality, debris, and leaks (downspouts and underground systems not included)

Gutters Image

Gutters zx

Drop files here or

Max. file size: 50 MB.

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Hose Bibs(Required)

N/A

Green

Yellow

Red

Hose Bibs Notes

Evaluate for leaks and operation. (note locations)

Hose Bibs Image

Hose Bibs zx

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Max. file size: 50 MB.

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Water Pressure

N/A

Green

Yellow

Red

Water Pressure Notes

Check the homes water pressure at the outside hose bib it should be between 40PSI and 80PSI (60 is the sweet spot) if higher than 80, it can cause failures to electronically controlled valves in appliances (dishwasher, clothes washer) NOTE: adjustments should not be made at the time of Evaluation.

Water Pressure Image

Water Pressure zx

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Max. file size: 50 MB.

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Siding(Required)

N/A

Green

Yellow

Red

Siding Notes

Visual evaluation for loose, missing, damaged, or deteriorated siding materials. Make recommendations.

Siding Image

Siding zx

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Max. file size: 50 MB.

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Masonry

N/A

Green

Yellow

Red

Masonry Notes

Visual evaluation for cracks, pointing issues, weep holes, spalling, etc.

Masonry Image

Masonry zx

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Max. file size: 50 MB.

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Overhead Lines(Required)

N/A

Green

Yellow

Red

Overhead Lines Notes

Visually evaluate attachment at home for deterioration or connection points failing/pulling away from the house. Also, look for vegetation that could be causing issues or could in the future (ivy growing on lines or dead tree limbs that could fall.)

Overhead Lines Image

Overhead Lines zx

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Max. file size: 50 MB.

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Window Wells(Required)

N/A

Green

Yellow

Red

Window Wells Notes

Window Wells Image

Window Wells zx

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Max. file size: 50 MB.

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Roofing/Flashing(Required)

N/A

Green

Yellow

Red

Roofing/Flashing Notes

Via roof edge from ladder and or binoculars, visually evaluate roof for damaged missing roofing materials and potential flashing issues. Also look at accessible plumbing vents for appropriate flashing/damage

Roofing/Flashing Image

Roofing/Flashing zx

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Max. file size: 50 MB.

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HVAC Compressor(s)(Required)

N/A

Green

Yellow

Red

HVAC Compressor(s) Notes

Check general condition and evidence of the coils being clogged with debris and pollen and advise

HVAC Compressor(s) 2 Notes

Check general condition and evidence of the coils being clogged with debris and pollen and advise

HVAC Compressor(s) 3 Notes

Check general condition and evidence of the coils being clogged with debris and pollen and advise

HVAC Compressor(s) 4 Notes

Check general condition and evidence of the coils being clogged with debris and pollen and advise

HVAC Compressor(s) 5 Notes

Check general condition and evidence of the coils being clogged with debris and pollen and advise

HVAC Compressor(s) 2

N/A

Green

Yellow

Red

HVAC Compressor(s) 3

N/A

Green

Yellow

Red

HVAC Compressor(s) 4

N/A

Green

Yellow

Red

HVAC Compressor(s) 5

N/A

Green

Yellow

Red

HVAC Compressor(s) Image

HVAC Compressor(s) 2 Image

HVAC Compressor(s) 3 Image

HVAC Compressor(s) 4 Image

HVAC Compressor(s) 5 Image

HVAC Compressor(s) zx

Drop files here or

Max. file size: 50 MB.

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Relative Humidity(Required)

N/A

Green

Yellow

Red

Relative Humidity Notes

At arrival, place humidistat in central area of home and document its readings at the end of the evaluation and advise if out of healthy range (45-60%)

Relative Humidity Image

Relative Humidity zx

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Max. file size: 50 MB.

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General Safety(Required)

N/A

Green

Yellow

Red

General Safety Notes

Throughout the evaluation process, identify safety hazards and make recommendations. Examples: flooring trip hazards from material failure, deteriorated deck structure, loose stair treads, uneven surfaces, materials stored too close to Furnace/water heater, visible mold, etc.

General Safety Image

General Safety zx

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Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Smoke Detectors(Required)

N/A

Green

Yellow

Red

Smoke Detectors Notes

Check age (7 year lifespan) and status if interconnected. Recommend battery replacement schedule. (some have 10 yr. batteries) also, check for code compliance.

Smoke Detectors Image

Smoke Detectors zx

Drop files here or

Max. file size: 50 MB.

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Handrails(Required)

N/A

Green

Yellow

Red

Handrails Notes

Check for securement and safety.

Handrails Image

Handrails zx

Drop files here or

Max. file size: 50 MB.

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Ceiling for water leaks(Required)

N/A

Green

Yellow

Red

Ceiling for water leaks Notes

Visual evaluation for staining from moisture.

Ceiling for water leaks Image

Ceiling for water leaks zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Interior wall/ceiling condition(Required)

N/A

Green

Yellow

Red

Interior wall/ceiling condition Notes

Cracks, deterioration, damage etc.

Interior wall/ceiling condition Image

Interior wall/ceiling condition zx

Drop files here or

Max. file size: 50 MB.

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Ceiling Fans(Required)

N/A

Green

Yellow

Red

Ceiling Fans Notes

Check operation and direction for the season, and make recommendations for changing direction for the seasons. (They should blow down in warm weather and draw up in cold weather).

Ceiling Fans Image

Ceiling Fans zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Bathroom Grout & Caulk(Required)

N/A

Green

Yellow

Red

Bathroom Grout & Caulk Notes

Visual evaluation for loose missing grout/caulk and signs of leaks from the bathing area.

Bathroom Grout & Caulk Image

Bathroom Grout & Caulk zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Hot water temperature(Required)

N/A

Green

Yellow

Red

Hot water temperature Notes

Check hot water temperature at bathing fixtures (max 120F) 140F is recommended for other areas.

Hot water temperature Image

Hot water temperature zx

Drop files here or

Max. file size: 50 MB.

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Water Valves(Required)

N/A

Green

Yellow

Red

Water Valves Notes

Visual evaluation for leaks

Water Valves Image

Water Valves zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Sink Traps(Required)

N/A

Green

Yellow

Red

Sink Traps Notes

Run water in the fixture and check for good drain operation and stopper mechanism operation if applicable. Check for visible signs of leaking. Look for improper attachment to waste arm in older homes (grey rubber connection with clamps).

Sink Traps Image

Sink Traps zx

Drop files here or

Max. file size: 50 MB.

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GFCI/AFCI Outlets(Required)

N/A

Green

Yellow

Red

GFCI/AFCI Outlets Notes

Check for general condition and operate the test reset buttons and check wiring with tester.

GFCI/AFCI Outlets Image

GFCI/AFCI Outlets zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Cooktop(Required)

N/A

Green

Yellow

Red

Cooktop Notes

General condition and operation (check for leaks if not fueled by Electricity)

Cooktop 2 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Cooktop 3 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Cooktop 4 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Cooktop 5 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Cooktop 2

N/A

Green

Yellow

Red

Cooktop 3

N/A

Green

Yellow

Red

Cooktop 4

N/A

Green

Yellow

Red

Cooktop 5

N/A

Green

Yellow

Red

Cooktop Image

Cooktop 2 Image

Cooktop 3 Image

Cooktop 4 Image

Cooktop 5 Image

Cooktop zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Range(Required)

N/A

Green

Yellow

Red

Range Notes

General condition and operation (check for leaks if not fueled by Electricity)

Range 2 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Range 3 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Range 4 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Range 5 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Range 2

N/A

Green

Yellow

Red

Range 3

N/A

Green

Yellow

Red

Range 4

N/A

Green

Yellow

Red

Range 5

N/A

Green

Yellow

Red

Range Image

Range 2 Image

Range 3 Image

Range 4 Image

Range 5 Image

Range zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Oven(s)(Required)

N/A

Green

Yellow

Red

Oven(s) Notes

General condition and operation (check for leaks if not fueled by Electricity)

Oven(s) 2 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Oven(s) 3 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Oven(s) 4 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Oven(s) 5 Notes

General condition and operation (check for leaks if not fueled by Electricity)

Oven(s) 2

N/A

Green

Yellow

Red

Oven(s) 3

N/A

Green

Yellow

Red

Oven(s) 4

N/A

Green

Yellow

Red

Oven(s) 5

N/A

Green

Yellow

Red

Oven(s) Image

Oven(s) 2 Image

Oven(s) 3 Image

Oven(s) 4 Image

Oven(s) 5 Image

Oven(s) zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Microwave(Required)

N/A

Green

Yellow

Red

Microwave Notes

General condition and operation

Microwave 2 Notes

General condition and operation

Microwave 3 Notes

General condition and operation

Microwave 4 Notes

General condition and operation

Microwave 5 Notes

General condition and operation

Microwave 2

N/A

Green

Yellow

Red

Microwave 3

N/A

Green

Yellow

Red

Microwave 4

N/A

Green

Yellow

Red

Microwave 5

N/A

Green

Yellow

Red

Microwave Image

Microwave 2 Image

Microwave 3 Image

Microwave 4 Image

Microwave 5 Image

Microwave zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Range Hood(Required)

N/A

Green

Yellow

Red

Range Hood Notes

General condition and operation

Range Hood 2 Notes

General condition and operation

Range Hood 3 Notes

General condition and operation

Range Hood 4 Notes

General condition and operation

Range Hood 5 Notes

General condition and operation

Range Hood 2

N/A

Green

Yellow

Red

Range Hood 3

N/A

Green

Yellow

Red

Range Hood 4

N/A

Green

Yellow

Red

Range Hood 5

N/A

Green

Yellow

Red

Range Hood Image

Range Hood 2 Image

Range Hood 3 Image

Range Hood 4 Image

Range Hood 5 Image

Range Hood zx

Drop files here or

Max. file size: 50 MB.

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empty to support CSS :empty selector. -->

Refrigerator(Required)

N/A

Green

Yellow

Red

Refrigerator 2

N/A

Green

Yellow

Red

Refrigerator 3

N/A

Green

Yellow

Red

Refrigerator 4

N/A

Green

Yellow

Red

Refrigerator 5

N/A

Green

Yellow

Red

Refrigerator Notes

General condition and operation. If accessible, check for the ice maker supply valve for leaks. Note filter model if applicable.______________

Refrigerator 2 Notes

General condition and operation. If accessible, check for the ice maker supply valve for leaks. Note filter model if applicable.______________

Refrigerator 3 Notes

General condition and operation. If accessible, check for the ice maker supply valve for leaks. Note filter model if applicable.______________

Refrigerator 4 Notes

General condition and operation. If accessible, check for the ice maker supply valve for leaks. Note filter model if applicable.______________

Refrigerator 5 Notes

General condition and operation. If accessible, check for the ice maker supply valve for leaks. Note filter model if applicable.______________

Refrigerator Image

Refrigerator 2 Image

Refrigerator 3 Image

Refrigerator 4 Image

Refrigerator 5 Image

Refrigerator zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Dishwasher(Required)

N/A

Green

Yellow

Red

Dishwasher Notes

General condition and operation and identify if leaks are present

Dishwasher 2 Notes

General condition and operation and identify if leaks are present

Dishwasher 3 Notes

General condition and operation and identify if leaks are present

Dishwasher 4 Notes

General condition and operation and identify if leaks are present

Dishwasher 5 Notes

General condition and operation and identify if leaks are present

Dishwasher 2

N/A

Green

Yellow

Red

Dishwasher 3

N/A

Green

Yellow

Red

Dishwasher 4

N/A

Green

Yellow

Red

Dishwasher 5

N/A

Green

Yellow

Red

Dishwasher Image

Dishwasher 2 Image

Dishwasher 3 Image

Dishwasher 4 Image

Dishwasher 5 Image

Dishwasher zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Garbage Disposal(Required)

N/A

Green

Yellow

Red

Garbage Disposal Notes

General condition and operation and identify if leaks are present

Garbage Disposal 2 Notes

General condition and operation and identify if leaks are present

Garbage Disposal 3 Notes

General condition and operation and identify if leaks are present

Garbage Disposal 4 Notes

General condition and operation and identify if leaks are present

Garbage Disposal 5 Notes

General condition and operation and identify if leaks are present

Garbage Disposal 2

N/A

Green

Yellow

Red

Garbage Disposal 3

N/A

Green

Yellow

Red

Garbage Disposal 4

N/A

Green

Yellow

Red

Garbage Disposal 5

N/A

Green

Yellow

Red

Garbage Disposal Image

Garbage Disposal 2 Image

Garbage Disposal 3 Image

Garbage Disposal 4 Image

Garbage Disposal 5 Image

Garbage Disposal zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Clothes Washer(Required)

N/A

Green

Yellow

Red

Clothes Washer Notes

Check condition of supply hoses for deterioration, securement of drain hose to stop box and general condition and operation

Clothes Washer 2 Notes

Check condition of supply hoses for deterioration, securement of drain hose to stop box and general condition and operation

Clothes Washer 3 Notes

Check condition of supply hoses for deterioration, securement of drain hose to stop box and general condition and operation

Clothes Washer 4 Notes

Check condition of supply hoses for deterioration, securement of drain hose to stop box and general condition and operation

Clothes Washer 5 Notes

Check condition of supply hoses for deterioration, securement of drain hose to stop box and general condition and operation

Clothes Washer 2

N/A

Green

Yellow

Red

Clothes Washer 3

N/A

Green

Yellow

Red

Clothes Washer 4

N/A

Green

Yellow

Red

Clothes Washer 5

N/A

Green

Yellow

Red

Clothes Washer Image

Clothes Washer 2 Image

Clothes Washer 3 Image

Clothes Washer 4 Image

Clothes Washer 5 Image

Clothes Washer zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

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Clothes Dryer(Required)

N/A

Green

Yellow

Red

Clothes Dryer Notes

Operate the dryer and Check the exterior exhaust point (if accessible) for appropriate air flow, damage and signs of blockage. Evaluate dryer for appropriate materials for the ducting to the outside (freestanding units only) (check for leaks if not fueled by Electricity)

Clothes Dryer 2 Notes

Clothes Dryer 3 Notes

Clothes Dryer 4 Notes

Clothes Dryer 5 Notes

Clothes Dryer 2

N/A

Green

Yellow

Red

Clothes Dryer 3

N/A

Green

Yellow

Red

Clothes Dryer 4

N/A

Green

Yellow

Red

Clothes Dryer 5

N/A

Green

Yellow

Red

Clothes Dryer Image

Clothes Dryer 2 Image

Clothes Dryer 3 Image

Clothes Dryer 4 Image

Clothes Dryer 5 Image

Clothes Dryer zx

Drop files here or

Max. file size: 50 MB.

<!-- Leave

empty to support CSS :empty selector. -->

Fireplace(s)(Required)

N/A

Green

Yellow

Red

Fireplace(s) Notes

Visually evaluate the firebox for deteriorated fire brick/mortar, damper operation, condition, and flue condition

Fireplace(s) 2 Notes

Visually evaluate the firebox for deteriorated fire brick/mortar, damper operation, condition, and flue condition

Fireplace(s) 3 Notes

Visually evaluate the firebox for deteriorated fire brick/mortar, damper operation, condition, and flue condition

Fireplace(s) 4 Notes

Visually evaluate the firebox for deteriorated fire brick/mortar, damper operation, condition, and flue condition

Fireplace(s) 5 Notes

Visually evaluate the firebox for deteriorated fire brick/mortar, damper operation, condition, and flue condition

Fireplace(s) 2

N/A

Green

Yellow

Red

Fireplace(s) 3

N/A

Green

Yellow

Red

Fireplace(s) 4

N/A

Green

Yellow

Red

Fireplace(s) 5

N/A

Green

Yellow

Red

Fireplace(s) Image

Fireplace(s) 2 Image

Fireplace(s) 3 Image

Fireplace(s) 4 Image

Fireplace(s) 5 Image

Fireplace(s) zx

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Lighting(Required)

N/A

Green

Yellow

Red

Lighting Notes

Visually evaluate for burnt-out bulbs (hard-wired fixtures only) and make recommendations.

Lighting Image

Lighting zx

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Max. file size: 50 MB.

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Window/Door(Required)

N/A

Green

Yellow

Red

Window/Door Notes

Check operation, glass seals, and general condition. Check interior door to garage for fire rating.

Window/Door Image

Window/Door zx

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Max. file size: 50 MB.

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Door Locks(Required)

N/A

Green

Yellow

Red

Door Locks Notes

Check operation, glass seals, and general condition. Check interior door to garage for fire rating.

Door Locks Image

Door Locks zx

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Max. file size: 50 MB.

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Attic Insulation(Required)

N/A

Green

Yellow

Red

Attic Insulation Notes

Check for smooth operation and alignment with the strikes. Make recommendations if faults are found.

Attic Insulation Image

Attic Insulation zx

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Max. file size: 50 MB.

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Overhead Door(Required)

N/A

Green

Yellow

Red

Overhead Door Notes

Check for smooth operation, safety beam at doorway functionality, force settings of the opener, seal condition, light bulbs in the opener, and remote functionality.

Overhead Door 2 Notes

Check for smooth operation, safety beam at doorway functionality, force settings of the opener, seal condition, light bulbs in the opener, and remote functionality.

Overhead Door 3 Notes

Check for smooth operation, safety beam at doorway functionality, force settings of the opener, seal condition, light bulbs in the opener, and remote functionality.

Overhead Door 4 Notes

Check for smooth operation, safety beam at doorway functionality, force settings of the opener, seal condition, light bulbs in the opener, and remote functionality.

Overhead Door 5 Notes

Check for smooth operation, safety beam at doorway functionality, force settings of the opener, seal condition, light bulbs in the opener, and remote functionality.

Overhead Door 2

N/A

Green

Yellow

Red

Overhead Door 3

N/A

Green

Yellow

Red

Overhead Door 4

N/A

Green

Yellow

Red

Overhead Door 5

N/A

Green

Yellow

Red

Overhead Door Image

Overhead Door 2 Image

Overhead Door 3 Image

Overhead Door 4 Image

Overhead Door 5 Image

Overhead Door zx

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Max. file size: 50 MB.

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Water Heater(Required)

N/A

Green

Yellow

Red

Water Heater Notes

Check for leaks at water heater, valves and expansion tank and rust/deterioration. For gas: check for signs of flue blockage (fine particle build up on top of heater, odor of combustion gas) make sure the flue is going “up hill” and no aluminum joints are in the metal flue system. ensure nothing is being stored within 2-3′ of unit (especially with gas/propane fueled heater)

Water Heater 2 Notes

Water Heater 3 Notes

Water Heater 4 Notes

Water Heater 5 Notes

Water Heater 2

N/A

Green

Yellow

Red

Water Heater 3

N/A

Green

Yellow

Red

Water Heater 4

N/A

Green

Yellow

Red

Water Heater 5

N/A

Green

Yellow

Red

Water Heater Image

Water Heater 2 Image

Water Heater 3 Image

Water Heater 4 Image

Water Heater 5 Image

Water Heater zx

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Max. file size: 50 MB.

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Main Water Shutoff(Required)

N/A

Green

Yellow

Red

Main Water Shutoff Notes

Check for leaks at valve stem

Main Water Shutoff Image

Main Water Shutoff zx

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Max. file size: 50 MB.

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Sump Pumps(Required)

N/A

Green

Yellow

Red

Sump Pumps Notes

Check for operation by running water in sump pit and try to identify its age. Recommend replacement if 7-10 years old or older.

Sump Pumps 2 Notes

Check for operation by running water in sump pit and try to identify its age. Recommend replacement if 7-10 years old or older.

Sump Pumps 3 Notes

Check for operation by running water in sump pit and try to identify its age. Recommend replacement if 7-10 years old or older.

Sump Pumps 4 Notes

Check for operation by running water in sump pit and try to identify its age. Recommend replacement if 7-10 years old or older.

Sump Pumps 5 Notes

Check for operation by running water in sump pit and try to identify its age. Recommend replacement if 7-10 years old or older.

Sump Pumps 2

N/A

Green

Yellow

Red

Sump Pumps 3

N/A

Green

Yellow

Red

Sump Pumps 4

N/A

Green

Yellow

Red

Sump Pumps 5

N/A

Green

Yellow

Red

Sump Pumps Image

Sump Pumps 2 Image

Sump Pumps 3 Image

Sump Pumps 4 Image

Sump Pumps 5 Image

Sump Pumps zx

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Natural gas/propane leaks(Required)

N/A

Green

Yellow

Red

Natural gas/propane leaks Notes

Check for leaks and advise if found

Natural gas/propane leaks Image

Natural gas/propane leaks zx

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Max. file size: 50 MB.

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Plumbing waste system(Required)

N/A

Green

Yellow

Red

Plumbing waste system Notes

Iron stacks: visually evaluate for leaks, cracks and “barnacle” rust and deterioration. PVC/ABS/Copper stacks visually evaluate for leaks and cracks. Pour 1qt +/- of water in floor drains. Water Supply: copper/Iron/PEX/PVC visually evaluate for signs of leaks or damage. Only accessible/visible parts of the plumbing system are included

Plumbing waste system 2 Notes

Plumbing waste system 3 Notes

Plumbing waste system 4 Notes

Plumbing waste system 5 Notes

Plumbing waste system 2

N/A

Green

Yellow

Red

Plumbing waste system 3

N/A

Green

Yellow

Red

Plumbing waste system 4

N/A

Green

Yellow

Red

Plumbing waste system 5

N/A

Green

Yellow

Red

Plumbing waste system Image

Plumbing waste system 2 Image

Plumbing waste system 3 Image

Plumbing waste system 4 Image

Plumbing waste system 5 Image

Plumbing waste system zx

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Max. file size: 50 MB.

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Electrical Panel(Required)

N/A

Green

Yellow

Red

Electrical Panel Notes

Visually identify the brand and note if on the danger list “FPE, ZINZCO, PUSHMATIC” and make recommendations to have replaced if found. Check that there is 3′ clearance in front of the panel and visually evaluate for rust and deterioration.

Electrical Panel 2 Notes

Electrical Panel 3 Notes

Electrical Panel 4 Notes

Electrical Panel 5 Notes

Electrical Panel 2

N/A

Green

Yellow

Red

Electrical Panel 3

N/A

Green

Yellow

Red

Electrical Panel 4

N/A

Green

Yellow

Red

Electrical Panel 5

N/A

Green

Yellow

Red

Electrical Panel Image

Electrical Panel 2 Image

Electrical Panel 3 Image

Electrical Panel 4 Image

Electrical Panel 5 Image

Electrical Panel zx

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Max. file size: 50 MB.

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Furnace(s)(Required)

N/A

Green

Yellow

Red

Furnace(s) Notes

Check general condition and note any issues with rust or potential hazards. Note: noting should be stored within 2′ of the furnace

Furnace(s) 2 Notes

Check general condition and note any issues with rust or potential hazards. Note: noting should be stored within 2′ of the furnace

Furnace(s) 3 Notes

Check general condition and note any issues with rust or potential hazards. Note: noting should be stored within 2′ of the furnace

Furnace(s) 4 Notes

Check general condition and note any issues with rust or potential hazards. Note: noting should be stored within 2′ of the furnace

Furnace(s) 5 Notes

Check general condition and note any issues with rust or potential hazards. Note: noting should be stored within 2′ of the furnace

Furnace(s) 2

N/A

Green

Yellow

Red

Furnace(s) 3

N/A

Green

Yellow

Red

Furnace(s) 4

N/A

Green

Yellow

Red

Furnace(s) 5

N/A

Green

Yellow

Red

Furnace(s) Image

Furnace(s) 2 Image

Furnace(s) 3 Image

Furnace(s) 4 Image

Furnace(s) 5 Image

Furnace(s) zx

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Max. file size: 50 MB.

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Check Furnace Filters(Required)

N/A

Green

Yellow

Red

Check Furnace Filters Notes

Note filter condition, Merv rating and location for future maintenance. Filter size____________ Date Changed_________

Check Furnace Filters Image

Check Furnace Filters zx

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Max. file size: 50 MB.

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Basement(Required)

N/A

Green

Yellow

Red

Basement Notes

Evaluate for visible cracks and leaks

Basement Image

Basement zx

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Max. file size: 50 MB.

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Crawl Space(Required)

N/A

Green

Yellow

Red

Crawl Space Notes

Evaluate for visible cracks and leaks falling insulation as visible from access point

Crawl Space Image

Crawl Space zx

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Max. file size: 50 MB.

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Additional Notes

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