Roof Inspection Form

Applicant/Insured Name:

Sample Customer

Application/Policy #:

Address Inspected:

123 Sample Street, Sample City, FL 00000

Date of Inspection:

07/10/2026

This sample Roof Inspection Form (or a similar form) must be completed and signed by a Florida-licensed professional. The form will not be accepted without the dated signature of one of the following appropriately licensed inspectors:

• General, residential, building or roofing contractor • Building code inspector • Florida-licensed home inspector

Note: This form does not verify loss mitigation features. Use Uniform Mitigation Verification Inspection Form OIR-B1-1802.

Be advised that Underwriting will rely on the information in this sample form, or a similar form, that is obtained from the Florida licensed professional of your choice. This information is used only to determine insurability and is not a warranty or assurance of the suitability, fitness or longevity of the roof inspected.

Roof (Photos of each roof slope showing the roof's condition must be submitted with this form.)

Predominant Roof

Covering material: Architectural / Asphalt Shingles

Roof age (years): 1

Remaining useful life (years): 19

Date of last roofing permit: 10/14/2025

Date of last update: 2025

If updated (check one):

✔ Full replacement

Partial replacement

Overall condition:

✔ Satisfactory

Unsatisfactory (explain below)

Secondary Roof

Covering material:

Roof age (years):

Remaining useful life (years):

Date of last roofing permit:

Date of last update:

If updated (check one):

Full replacement

Partial replacement

Overall condition:

Satisfactory

Unsatisfactory (explain below)

Any visible signs of damage / deterioration?

(check all that apply and explain below)

Cracking

Cupping/curling

Excessive granule loss

Exposed asphalt

Exposed felt

Missing/loose/cracked tabs or tiles

Soft spots in decking

Visible hail damage

Any visible signs of damage / deterioration?

(check all that apply and explain below)

Cracking

Cupping/curling

Excessive granule loss

Exposed asphalt

Exposed felt

Missing/loose/cracked tabs or tiles

Soft spots in decking

Visible hail damage

Any visible signs of leaks? Yes ✔ No

Attic/underside of decking Yes ✔ No

Interior ceilings Yes ✔ No

Any visible signs of leaks? Yes ✔ No

Attic/underside of decking Yes ✔ No

Interior ceilings Yes ✔ No

Roof Inspection Form

Additional Comments/Observations (use additional pages if needed):

All Roof Inspection Forms must be completed and signed by a verifiable Florida-licensed building contractor, engineer, architect, or home inspector.
I certify that the above statements are true and correct.

Inspector Signature	Owner Title	HI-0000000 License Number	07/10/2026 Date
Sample Inspector Inspector Name	Inspector Network Company Name	Home Inspector License Type	8559840941 Work Phone

Special Instructions

This sample Roof Inspection Form includes the minimum data needed for Underwriting to properly evaluate a property application. While this specific form is not required, any other inspection report submitted for consideration must include at least this level of detail to be acceptable.

Photo Requirements

Photos must accompany each Roof Inspection Form. The minimum photo requirements include:

Roof: Each slope
All hazards or deficiencies

Documenting the Condition of Each System

The Florida-licensed inspector is required to certify the condition of the roofing system. Acceptable Condition means that each system is working as intended and there are no visible hazards or deficiencies.

Additional Comments or Observations

This section of the Roof Inspection Form must be completed with full details/descriptions if any of the following are noted on the inspection:

Updates: Identify the types of updates, dates completed and by whom
Any visible hazards or deficiencies
Any roof determined not to be in good working order

Note to All Agents

The writing agent must review in advance each Roof Inspection Form submitted with an application for coverage. It is the agent's responsibility to ensure that all rules and requirements are met before the application is bound. Agents may not submit applications for properties with roof(s) not in good working order or with existing hazards/deficiencies.

PHOTO APPENDIX

Roof Photos