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Seller Disclosure
For your protection and safety of the home inspector, answers to the following questions should be obtained from the property owner prior to your scheduled home inspection. This disclosure form is not a substitute for any inspections, nor is it a warranty.
Questions For Home Owner: Your voluntary responses will help the prospective homebuyer/s with their
buying plans and help the home inspector in evaluating conditions he/she finds. This disclosure form is
not a warranty of the property either by you, (the seller) or by your real estate agent.
1. How long have you been the owner of this property? ____________________________________ ______________________________________________________________________________
2. What is the approximate age of the building? __________________________________________
______________________________________________________________________________
2b. Ages of the additions, if any? _____________________________________________________
______________________________________________________________________________
3. Are there any appliances, equipment or fixtures the inspector should not attempt to operate?
[ ] No [ ] Yes, please explain: _______________________________________________________
4. Are there any rooms or areas of the building the inspector should not enter?
[ ] No [ ] Yes, please explain: _______________________________________________________
5. Are there crawl spaces or other areas in / under the building that the inspector might not readily find?
[ ] No [ ] Yes, please explain: _______________________________________________________
6. Are you aware of any hazards an inspector might encounter in the living areas, attic, fireplaces,
basement or crawl spaces, such as pets, raccoons, rodents, bats, snakes, bees, hornets or wasps?
[ ] No [ ] Yes, please explain: _______________________________________________________
7. Are you aware of whether the property is located in a flood plain (is flood insurance required)?
[ ] No [ ] Yes
7b. Are you aware of whether any part of the property is in a designated wetland area?
[ ] No [ ] Yes
7c. Are you aware of whether the property has ever been under water / flooded?
[ ] No [ ] Yes, please explain: _______________________________________________________
7d. Are there any sump pumps in the basement?
[ ] No [ ] Yes If yes, how many? _____________________________________________________
8. Are you aware of any exterior water penetration through the roof, windows, doors, walls or through any other area of the building or into the basement or crawl space (if any are present)?
[ ] No [ ] Yes, please explain: _______________________________________________________
9. Are you aware of any exterior cladding / siding damage, defects or deficiencies?
[ ] No [ ] Yes, please explain: _______________________________________________________
10. Are you aware of any structural problems / damage, defects or deficiencies with the foundation,
masonry walls, wood framing, metal framing or any other part of the building?
[ ] No [ ] Yes, please explain: _______________________________________________________
11. What is the approximate age of the roof surface on the main section of building?
_________________________
11b. On the additions, if any? _______________________________________________________
11c. Are you aware of any roof surface repairs or replacements within the past 3 years?
[ ] No [ ] Yes, please explain: _______________________________________________________
12. What is the approximate age of the heater / boiler / furnace or heat pump? ___________________
______________________________________________________________________________
12b. Are you aware of any heating system repairs or replacements during the past 3 years?
[ ] No [ ] Yes, please explain: _______________________________________________________
13. What is the approximate age of the central air conditioning system? ________________________
______________________________________________________________________________
[ ] Not Applicable
13b. Are you aware of any central air conditioning system repairs or replacements during the past 3
years, including the addition of refrigerant to the system?
[ ] No [ ] Yes, please explain: _______________________________________________________
14. Are you aware of any electrical defects, deficiencies, problems or safety issues (this includes fuses that blow out or circuit breakers that trip more than once)?
[ ] No [ ] Yes, please explain: _______________________________________________________
14b. Are you aware of any electrical work having been done during the past 3 years?
[ ] No [ ] Yes, please explain: _______________________________________________________
15. What is the approximate age of the water heater? _____________________________________
15b. Are you aware of any plumbing problems, leaks, deficiencies, or plumbing safety issues?
[ ] No [ ] Yes, please explain: _______________________________________________________
15c. Are you aware of any plumbing work having been done during the past 3 years?
[ ] No [ ] Yes, please explain: _______________________________________________________
16. Are you aware of any remodeling, alterations, repairs or replacements done without building permits,
electrical permits, mechanical or plumbing permits issued by the municipal or governmental authorities?
[ ] No [ ] Yes, please explain: _______________________________________________________
17. Are you aware of the property having ever been inspected for termites, carpenter ants or any other
wood destroying insects or organisms?
[ ] No [ ] Yes, is the inspection report available
[ ] No [ ] Yes
17b. Are you aware of the property having ever been treated for termites, carpenter ants or any other
wood destroying insects or organisms?
[ ] No [ ] Yes, please explain: ______________________________________________________
18. Are you aware of any history of fire or smoke damage in the building?
[ ] No [ ] Yes, please explain: ______________________________________________________
19. Are you aware of any environmental health or safety issues within the building?
(Including but not limited to radon gas, lead paint, hazardous mold or asbestos.)
[ ] No [ ] Yes, please explain: ______________________________________________________
20. Are you aware of the building having ever been tested for radon gas?
[ ] No [ ] Yes, are the results available?
[ ] No [ ] Yes
21. Are you aware of the building having ever been inspected / tested for lead paint?
[ ] No [ ] Yes, are the results available?
[ ] No [ ] Yes
22. Are you aware of the building having ever been inspected / tested for hazardous mold?
[ ] No [ ] Yes, are the results available?
[ ] No [ ] Yes
23. Are you aware of any environmental health or safety issues around the building, other than the items
above (such as underground fuel oil tanks, abandoned wells, abandoned cesspools or septic tanks)?
[ ] No [ ] Yes, please explain: ______________________________________________________
24. Is there an on-site / private sewage system for the building (such as a septic or cesspool?)
[ ] No [ ] Yes
24b. If on a private system, are you aware of it being inspected during the past 3 years?
[ ] No [ ] Yes, is the inspection report available?
[ ] No [ ] Yes
24c. If on a private system, are you aware of any defects, deficiencies, or problems with it?
[ ] No [ ] Yes, please explain: ______________________________________________________
24d. If on a public / municipal sewage system, are you aware of any defects, deficiencies or problems in
regards to how it affects this building? (This includes tree roots blocking the pipes or sewage backup
from other causes.)
[ ] No [ ] Yes, please explain: ______________________________________________________
25. Is there an on-site water supply system, such as a well?
[ ] No [ ] Yes, Is this water supply distributed to the building?
[ ] No [ ] Yes
25b. If yes, are you aware of any defects, deficiencies, problems or health concerns with it?
[ ] No [ ] Yes, please explain: ______________________________________________________
25c. Are you aware of any water quality testing having been done in the past 3 years?
[ ] No [ ] Yes, are the test results available?
[ ] No [ ] Yes
25d. If on a public / municipal water supply system, are you aware of any defects, deficiencies, or
problems in regards to how it affects this building? (This includes low water pressure or flow.)
[ ] No [ ] Yes, please explain: ______________________________________________________
26. Are you aware (during your ownership) of whether the property / building has been inspected by a private home inspector?
[ ] No [ ] Yes
26b. If yes, was this inspection conducted for another prospective buyer of this building / property?
[ ] No [ ] Yes
26c. If yes, was something discovered during the inspection that caused the prospective buyer to rescind his/her offer to purchase?
[ ] No [ ] Yes, please explain: ______________________________________________________
_____________________________________________________________________________
Additional Comments: (Attach a separate page if needed.) _________________________________
_____________________________________________________________________________
Today's Date_____________________
Owner's Name - Please Print Owner's Name - Please Sign
2005® Hawk I Home Inspections, L.L.C.
