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INSPECTION REPORT FORMInstallation

Inspection Date: Inspector Name:

Inspector CP #: Claim #:

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Claim #:

I. GENERAL INFORMATION

Commissioning Party’s Name:

Address:

City: State: Zip:

Contact Number: Email:

Homeowner/Building Owner’s Name:

Address:

City: State: Zip:

Contact Number: Email:

Flooring Contractor’s Name:

Address:

City: State: Zip:

Contact Number: Email:

General Contractor’s Name:

Address:

City: State: Zip:

Contact Number: Email:

Manufacturer’s Name:

Address:

City: State: Zip:

Main Contact Info: Title:

Contact Number: Email:

Jobsite Visit Date: Time:

II. JOBSITE INFORMATION

Residential Commercial New Construction Remodel

Single Family Duplex Condo Apartment Complex

OCCUPANT INFORMATION# of Children: Pets:# of Adults:

Retailer’s Name:

Address:

City: State: Zip:

Main Contact Info: Title:

Contact Number: Email:

Age of Building: Yes NoOccupied: # of levels:

Date Sold to End-user:Date of Installation:Date Complaint First Noticed: Reported to: Unusual Events:Cleaning Products/Methods Used:

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III. STATEMENT OF CONCERN

IV. CLAIM HISTORY

Date Reported: Date Occupied:

How Often:

Moisture Content at Installation: Moisture Meter Type: Name:Model: Meter Species Correction: Moisture Content Readings (include a range, average, and number of tests performed):

JOBSITE CONDITIONS AT INSTALLATIONProcess of Acclimation:

During Install:

Temperature (Interior)During Install:RH (Interior)During Install:HVAC Operational During Storage: Yes Location and Description of Storage Area at Jobsite:

No Yes No

Date of Completion: Date Delivered to Jobsite:

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Claim #:

Nail Glue Float

INSTALLATION METHOD

Floating Installation Method Locking Mechanism Edge GluedAdhesive Used: Perimeter Expansion: Type of Underlayment Used: Floor Measured for Flat: Yes NoMethod Flatness Measured: Tolerance: 3/16” in 10’ 1/8” in 6’

Movement within Flooring System: Additional Installation Information:

+/–+/–

IV. CLAIM HISTORY (CONTINUED)

+/–

Length: Gauge: # of Nailers used on the floor install:

Yes No

3/16” in 6’

Nail Installation Method

Fastener Type: Pneumatic Air Pressure Setting: Type/Brand of Nailers:Type of Underlayment Used: Floor Measured for Flat: Method Flatness Measured: Tolerance: 1/4” in 10’ +/–

Application Method:

New

Location(s):Isolation

Spread Rate:

Age of Concrete:+/–

Used# of Trowels Used: Subfloor Measured for Flat: Yes No Method Flatness Measured: Tolerance: 3/16” in 10’ +/– 1/8” in 6’ Construction Joints present:

Type: Construction: Control Method addressed at installation:

Amount of time before traffic was allowed on installed floor: Movement within Flooring System: Additional Installation Information:

Glue-Down Installation MethodAdhesive System Used (type/brand): Moisture Control System Used (type/brand): Trowel Used (type):

Movement within Flooring System: Additional Installation Information:

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COMMISSIONING PARTY COMMENTS

END-USER COMMENTS

IV. CLAIM HISTORY (CONTINUED)

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IV. CLAIM HISTORY (CONTINUED)

FLOORING CONTRACTOR COMMENTS

OTHER INVOLVED PARTY COMMENTS

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V. PHYSICAL DESCRIPTION

NEW CONSTRUCTION INFODate Home Completed: Date HVAC Fully Operational:

Condition of Existing Floor:CONCERNS

General Throughout Stabilized

Localized Progressing

Improving Other

Square Footage Delivered: % of Floor Affected: Total Sqft Material Installed:

FLOORING

Additional Info on Flooring Container:

Manufacturer:

Production date/Lot #: Sqft per Container:

ROOMS BEING INSPECTED

Entry: sqft Kitchen: sqft Hall(s): sqft Great Room: sqft Living Room: sqft Dining Room: sqft Nook: sqft Pantry: sqft

Formal: sqft Study: sqft Library: sqft Powder Bath: sqft Bath 1: sqft Bath 2: sqft Bath 3: sqft Bath 4: sqft

Bath 5: sqft Master Bedroom: sqft Bed 1: sqft Bed 2: sqft Bed 3: sqft Bed 4: sqft Bed 5: sqft Other Rooms: sqft

Home Faces: North South East WestEXTERIOR EVALUATION

Relation of Lot to Street: Relation of Lot to Neighbors:Lot Drainage Away from Foundation: Yes No Slope Angle Measurement: Gutters/Downspouts: Yes No Roof Overhang: Yes NoSoil Damp at Foundation: Yes No

Shrubs/Flowers/Planter Boxes at Foundation: Yes NoSprinklers/Irrigation: Yes No Established Landscape: Yes NoWater Source/Swimming Pool Nearby: Yes No Proximity to Structure:

Building is over: Basement Crawlspace Slab

Window-wells: Wet Dry Signs of Moisture Yes No

Visible Cracks in Foundation: Visible Exterior Damage:Yes No Yes No

Species:Engineered Solid

Strip (Width: )Plank Parquet

UnfinishedFactory Finished

Flooring thickness:

Approved Over Radiant Heat: Yes No Approved Below Grade: Yes No

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Has floor been through full cycle of seasons? Yes No

Thermostat Control Settings:

Programmable: Yes No Data Logger: Yes No

Operating: Yes NoHumidification/Dehumidification System: Yes No

Date of Last Service (if known):

V. PHYSICAL DESCRIPTION (CONTINUED)

Location of Heating: Above Below Floor Baseboard

Type of Heating System:Forced Air Electric Radiant

Wood Burning Stove Radiator Baseboard

Other: Type:

HVAC EVALUATIONHVAC System Operating: Yes No

Type Of Cooling System:

Central Air Conditioning Portable Air Conditioning Swamp Cooler

Underfloor Exhaust Fan

Other: Type:

Audible Noises – Locations:

Traffic Use: High Average LowAny Special or Unique Use:

Other Trades | Schedules prior to, during or after installation: SPECIAL CONSIDERATIONS

Please include reference to supporting audio/video.Description of Sound:

Factory Finish Issues:

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V. PHYSICAL DESCRIPTION (CONTINUED)

BELOW FLOORING SYSTEM EVALUATION

Crawl Space Evaluation

Open-Air Crawlspace Wall-Vented Crawlspace

Enclosed Crawlspace Ground is Dirt, Concrete, Gravel, Other

Standing Water Present: Yes NoCondensation Present: Yes No

Alkali/Discoloration on Foundation Walls: Yes No

Vapor Retarder Present: Seams Overlapped Yes No inches

Seams Sealed: Method of Sealing:Yes No

Percent of Ground Covered: %Plastic Taped up Foundation Walls: Yes No

Insulation on Foundation Walls: Yes NoInsulation between Joists: Yes No

Number of Vents: Open/Closed: Vents Present: Yes No

Humidistat Installed: Yes No

Basement Evaluation

Basement Finished/Unfinished: If Finished, Date Completed: Walk Out: Yes NoSpecify Side(s) below ground level: North South East WestWall Cracks Present: Location:Yes No

Operating: Sump Pump: Yes No Yes NoYes NoHVAC Vents Open to Basement:

Signs of Moisture Damage: Floor Stains: Yes NoPeeling Paint: Yes NoGapped Trim or Moldings: Yes NoRusty Nails: Yes No

Wood Subfloor EvaluationType of Wood Subfloor:

19/32” PS-1 CDX Plywood 19/32” PS-2 CDX OSB 23/32” PS-1 CDX Plywood 23/32” PS-2 CDX OSB

7/8” Plywood or OSB 1” x 6” Solid Board Particle Board

Joist Type:Joist Spacing:Visible Rot: Yes No

Other

Yes

Concrete Slab Evaluation:Relation of Slab Surface to Exterior Soil Line: inchesNormal Weight Concrete (min 3000 psi): UnknownNoLight Weight Gypsum Concrete: UnknownYes NoPre-Tension/Post-Tension Slab: UnknownYes NoMoisture Retarder used Below Slab: UnknownYes No

SUBFLOOR EVALUATION

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SUMMARY OF PHYSICAL DESCRIPTION

V. PHYSICAL DESCRIPTION (CONTINUED)

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HVAC Testing: Temperature: F/C Relative Humidity: %

VI. TESTING

Other Moisture Tests Conducted:

JOBSITE CONDITIONS AT INSPECTION

Moisture Meter Type: Name:Model: Meter Species Correction:

High Reading: Low Reading:

Average Moisture Content at Inspection:Floor: Top: Back:

FLOOR TESTSAverage Measurement of Individual Boards Face Width:

Average Measurement of Gaps:

Does pattern of issue convey a relationship with building mechanical systems or foundation or slab cracks and/or settlement? Yes No

Cupping Measurements: Buckling Measurements:

Measurement Across 10 Boards: Average:20 Boards:

Meter Used:

Number of Readings: Locations of High Readings:

Moisture Test Results (include number of tests performed):

Comparison Readings (baseboards, trim, door, cabinets, etc.):

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VI. TESTING (CONTINUED)

SUBSTRATE TESTING:

Wood Subfloor TestingMoisture Content Readings: High Reading: Low Reading: Moisture Test Results (include an average and number of tests performed):

Moisture on UndersideMoisture on Top Moisture in Core

Joist Moisture Content:

Moisture Meter Type: Name:Model:Meter Setting:

Comparison Readings (baseboards, trim, door, cabinets, etc.):

Meter (ASTM 2659) Other

Concrete Slab Testing (uninstalled f looring or destructive testing only) Moisture Test(s) Required by Flooring Manufacturer:

RH (ASTM 2170) Meter (ASTM 2659) CaCl (ASTM 1869) Other

Results of Required Test(s): Number of Tests: Location of Tests:

Moisture Test(s) Required by Adhesive Manufacturer:

RH (ASTM 2170) CaCl (ASTM 1869)Results of Required Test(s): Number of Tests: Location of Test(s):

Other Moisture Test(s) Conducted:

Results of Required Test(s): Location of Test(s):

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Distance from Ground to Underside of Joists: inches/cm

Joist Moisture Content: Moisture Content Underside Subfloor:

Meter Used:

Crawl Space TestingTemperature: F/C Relative Humidity: % Meter Used:

Basement Testing

Temperature: F/C Relative Humidity: % Meter Used:Moisture Content Underside Subfloor:Joist Moisture Content:

Meter Used:

VI. TESTING (CONTINUED)BELOW FLOORING SYSTEM TESTING:

ADDITIONAL TESTING INFORMATIONPlease list all of the tests performed along with the results and tools used for the tests. Add reference to supporting photos.

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VI. TESTING (CONTINUED)

ADDITIONAL TESTING INFORMATION

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Please list the source from which standards were applied. Then copy/paste specific areas ofcontent that were used in the process.

VII. APPLIED INDUSTRY STANDARDS:

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V. APPLIED INDUSTRY STANDARDS (CONTINUED)

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VII. CONCLUSION/CAUSE

Determined conclusion based on the facts, testing, observations, and relevant manufacturer/industryguidelines as supported within this report.

Signature: Date: