West Side Mutual Self Inspection - West Side Mutual Insurance Association

"*" indicates required fields

This form may take up to 1 hour to complete.

This property survey is solely for company underwriting purposes. Underwriting surveys and resulting request are for the benefit of this company and not for any other person. This survey is not intended to be, nor should it be, considered a substitute for inspections of the various heating, electrical and mechanical systems on your property. Those systems should be inspected and maintained by qualified professionals. This survey was not made to determine or warrant that the property or operation are safe or healthful or in compliance with any law, rule or regulation. Message and data rates may apply.

Consent*

I agree to the disclaimer above

Please answer a few questions so we can locate the correct policy for this self inspection.

Policy Number

Please provide your insurance policy number (if known)

Policyholder Name*

First Last

Policy Holder Phone*

Policy Holder Email*

Please provide us some details on the inspection property itself.

Property Address*

Street Address Address Line 2 City State ZIP Code

Do you have any pets on your property (excluding livestock)?*

Yes

How many pets?*

Please enter a number from 0 to 10.

Please describe your pet and their breed?

Please describe your pets and their breeds?

Do you have livestock or other animals on your property (excluding domesticated pets)?*

Yes

Please describe the livestock?*

(for example: 3 chickens, 3 goats)

Smoke detectors must be replaced every 6 to 10 years depending on the manufacturers requirements.

Smoke detectors that are expired may not function correctly even with fresh batteries and should be discarded.

If you have any questions about smoke detectors, please contact your local fire department.

Are the smoke detectors working and placed in areas as required by law or local ordinance?*

Yes

How recently has a self test been performed on the smoke detectors in your home?*

Smoke detectors should be checked every 6 months. Make sure to use the self test button on the smoke detector once every 6 months to ensure the device is still functional.

Where are fire extinguisher located in your home?*

Kitchen

Utility room

Great room/family room

Bedroom

Garage

Detached shed or storage area

Other Area Not Listed

No fire extinguishers present

Other fire extinguisher location

We now have a few questions about the heating and cooling systems present in your home.

What is the primary heat source for the home?

Does the home have central air conditioning?*

Yes

When was the current central A/C system installed in the home?

Is there a solid fuel burner present in the home?*

This includes corn, wood, or pellet burning stoves.

Yes

Who installed your solid fuel burner?*

Where is the solid fuel burner located?*

For example: Is it in an attached or detached structure or in your home? Or in the family room or basement?

You will now be asked to provide several interior photos to your home.

Never risk your safety to take a photograph

If you cannot safely take a photo of an item, skip uploading that photo and move on to the next item.

West Side Mutual will send a trained professional to take exterior photos.

Please provide us with a photo of the solid fuel burner.

Example photo of a woodburner

Photo of solid fuel burner

Please provide us with a photo of the warning label on the woodburner.

Example of a photo of an woordburner warning label

Photo of label on solid fuel burner

Please provide us with a photo of the main furnace that heats your home.

Example of a photo of furnace

Photo of Furnace

Please provide us with a photo of your water heater. Please make sure the release valve pipe (noted with red arrow in example photo) is in view on the photo.

Example photo of water heater