Inspection Form

Inspection Form

William E. Casey Insurer Services, Inc.
Company Name:

Other
Inspector's Name:
Assigned Inspector:
INSPECTORS CAN"T SEE THIS- FOR AUTOMATION
Insured's Name:
Type exactly how it appears on request
Agency:
Policy #:
Street Address
City
State
Zip Code
Inspection Date:

MonthDayYear
Date
Contact Name
Contact Information (Phone Number(s) & Email)
Include Lock Box info
Description of Risk:
Be as detailed as possible. Overall description of risk. List occupancy (# of units, what occupies each unit, (owner, tenant, vacant), commercial or residential.
Does the Insured Own the Building?

Other
Estimated Purchase Date:
When did the insured purchase the property?
Prior Losses

Other
Prior Loss Description:
List what the prior loss was and if it's been addressed. Take pictures.
Type of Inspection:
Does the risk contain utilities
Describe Occupancy (check all that apply):

Other
Does the inspection require a replacement cost?
Homeowners: Is the risk a single family dwelling, located within 10 miles of the coastline?
Does the risk contain a commercial kitchen?
Jencap/Quaker Only (Rental Income)

$ Enter Rental Amount $

Safety Insurance Only (office will fill this out)

Roof Type:

Other
Roof Covering:

Other
Roof Age:

Other
Roof Condition:

Other
Off-Street Parking:

Other
Garage:

Other
Outbuildings:

Other
Surrounding Area:
Swimming Pool:
Swimming Pool Type:

Other
Swimming Pool Security:

Other
Hot Tub:
Exposures

What is located to the left, right, and rear of the building/unit you are inspecting.
Left Exposure:

Other
Description:

Other
Right Exposure:

Other
Description:

Other
Rear Exposure:

Other
Description:

Other
Overall Condition of Exterior:
Exterior Hazards:
List Exterior Hazards and Recommendations:
Write N/A or None if no Hazards. Provide photos for each hazard.

Year Built:
Estimated Depreciation Age:
Based off updates to kitchen, baths, utilities, roof, etc.
Does the basement contain additional living area?

% Finished
Number of Kitchens
Number of Full Baths
Number of 3/4 Baths
Number of 1/2 Baths

Interior Flooring (list percentage for each)

Rows	Hardwood	Carpet	Tile	Vinyl	LVP	Engineered Wood	Laminated Wood	Other
%

Interior Ceilings (list percentage for each)

Rows	Drywall	Plaster	Suspended Tile	Wood	Wood Beams	Ceramic Tile	Tin	Other
%

Interior walls (list percentage for each)

Rows	Drywall	Plaster	Tile	Walpaper	Wainscoting	Board & Batten	Wood Paneling	Other
%

Additional Interior Features (list percentage for each)

Rows	Jacuzzi/hot tub	Spiral Staircase	Sauna	Wet Bar	Central Station Burglar Alarm	Central Vacuum	Skylights	Sliding Door
Number

Additional Exterior Features (list square footage for each)

Rows	Wood Deck	Composite Deck	Open Porch	Closed Porch	Other	Irrigation System
SF

Fireplace

Rows	Single Fireplace	Wood Stove	Pellet Stove	Gas Fireplace	Other
Number

Detached Structures

Rows	Sm Shed	Med Shed	Lg Shed	Built in BBQ	Other
Number

Business hours of operation:

Rows	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Hours

Exposures