65 Point Comprehensive Wellness Check-up

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Bathroom(s)
Sink Emergency Shut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Sink Faucet Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Sink Faucet Aerator Cleaned?
YesNo


Drain Piping
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Tub Faucet Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Tub Drain
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Shower Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Shower Drain
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Whirlpool/Spa Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


WC Tank
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Emergency Shut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Mounting
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Seat/Lid
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Dye Test
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


WC Anti-Siphon Valve
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Fill Valve Assembly
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WC Flapper
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Bidet
YesNoN/A


Duplicate section

Kitchen
Faucet
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Water Connections
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedOption 6


Sink Basket
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Emergency Shut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Disposal
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Waste Piping
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Dishwasher
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Maker Supply Line Filter
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Water Alarm Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Duplicate section

Laundry
Sink
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Faucet Drain Emerg. Shut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Faucet
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Washing Machine Hoses - HOT
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Washing Machine Hoses - COLD
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Emergency Shut OFF - HOT
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Emergency Shut OFF - COLD
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Braided Steel Burst-Proof Hoses
YesNo


Water Alarm Operation
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Duplicate section

Water Heater Checklist
Manufacturer



Model



Serial



Location



Age



Safety Mixing Valve
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Safety Pressure Relief Valve
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Emergency Water Shut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Water Connections
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Drain Pan
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Drain Valve
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Gas Connection
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Flue Connection
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Gas Supply Shut-off Valve
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Temperature
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Combustibles in Vicinity
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


WAGS or EQ Restraint
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Expansion Tank
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Flush Sediment
Yes, recommendNo, not needed


Sacrificial Anode Rod
Yes, recommendNo, not needed


Dip Tube
Yes, recommendNo, not needed


Duplicate section

Outside
Water Meter with Everything Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Water Pressure (PSIG)
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Water Main Cut Off
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replaced


Outside Hose Bib 1
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Outside Hose Bib 2
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Outside Hose Bib 3
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Outside Hose Bib 4
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Main Clean-Out
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedF - N/A


Duplicate section

Other
Water Softener Neutralizer
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Water Softener Bypass Explained
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedN/A


Water Purification System
A - Pass, functioning wellB - Signs of Wear, may need to be replaced next visitC - Area of Concern, may fail before next visitD - Needs Immediate Attention, high probability of failureE - Part is Broken, part must be replacedRecommend upgradeN/A


Check for Backflow
Yes, recommendNo, not needed


Hot Water Recirculation System