Address: Address:

Street

City

Structure Inspected Structure Inspected Main Building Other

Current Contract Current Contract Yes No Unknown

Date of last inspection (if current contract)

Original Treatment

Attic Attic Inaccessible None

Crawlspace: Crawlspace: Insulation No Insulation Inaccessible None (Slab House)

Furniture: Furniture: Yes No

Stored Items in Garage: Stored Items in Garage: Yes No

Inaccessible Areas:

Subterranean Termites Subterranean Termites Active Inactive None

Location

Signs of Treatment Signs of Treatment Yes No

What is the evidence of treatment?

Powder Post Beetles Powder Post Beetles Active Inactive None

Location

Old House Borers Old House Borers Active Inactive None

Location

Other Other Active Inactive None

Other

Location

Evidence of infestation from wood-destroying organisms was observed? Evidence of infestation from wood-destroying organisms was observed? Yes No

Conditions conducive to termite infestation: Conditions conducive to termite infestation: Yes No

Location

Other Comments

Moisture Readings Moisture Readings

LR %

RR %

LF %

RF %

Others:

Inspector