Please input your answers from the intake form below. Once you click submit, your answers will be submitted to MPI and the results scored and report prepared manually.

Within five days of receipt, we will send out by e-mail, a report of your risk score with opinions and an explanation, as well as specific recommendations of corrections that should be performed to minimize this risk.

PLEASE NOTE THAT THIS FORM IS FOR CUSTOMERS WHO HAVE PURCHASED THE MPI PRODUCT.
SUBMISSIONS WILL BE COMPARED TO PURCHASE RECORDS FOR THIS SERVICE AND ANY SUBMISSIONS RECEIVED WITHOUT PAYMENT FIRST WILL NOT BE PROCESSED.
* Full Name
 
* Email Address for Results (will be verified with address submitted with order)
 
* Contact Phone Number (if any questions about form)
 
Exterior 1. Please mark the primary type of exterior siding on the home:
  a. Masonry cladding (brick,block) - one layer thick
b. Structural masonry - two layers thick
c. Vinyl
d. Aluminum
e. Stucco
f. EFIS - Dryvit
g. Wood
h. Asphalt
i. Other
Exterior 2. If Dryvit is on exterior, are there openings in the Dryvit at junctions of projections or other?
  a. Yes
b. No
Exterior 3. Approximate age of home in years:
  a. 0-5
b. 6-10
c. 11-20
d. 21-30
e. Over 30
Exterior 4. Number of windows and doors:
  a. <15
b. 15-25
c. >25
Exterior 5. Window flashing: (usually angled metal strip over top edge of window)
  a. In place
b. Missing
Exterior 6. Caulk condition/around windows and junctions:
  a. Sealed well
b. A few openings
c. Dried, cracking, open and peeling out
Exterior 7. Space between neighboring homes:
  a. <10 ft
b. 10-40 ft
c. 40-100 ft
d. >100 ft
Exterior 8. Room Addition(s)?
  a. Yes
b. No
Exterior 9. Are there window wells in the ground along the foundation?
  a. Yes
b. No
Exterior 10. If so, are the window wells covered with a rainproof material? (If one, answer No)
  a. Yes
b. No
Exterior 11. If yes, are the covers pitched away from the foundation? (If one, answer No)
  a. Yes
b. No
Roofing 1. Flat Roof:
  a. Yes
b. No
Roofing 2. If a flat roof, is it: (If a steep roof skip this question)
  a. Built up tar
b. Modified bitumen
c. EPDM (a rolled plastic resin material)
d. Don't know
Roofing 3. Pitched roofing: (steepness)
  a. Low
b. Medium
c. High
Roofing 4. Shingle condition:
  a. A few missing shingles
b. Shingles curled at their edges
c. Shingles shrunk with wide spacing between shingles
d. Laying flat and OK
Roofing 5. Shingle Type:
  a. Asphalt/Fiberglass
b. Wood/Cedar
c. Metal
d. Ceramic
e. Rolled
Roofing 6. Number of roof valleys: (sloped intersections of sloped roof sections)
  a. None
b. 1-3
c. 4-6
d. >6
Roofing 7. Number of chimney chases:
  a. None
b. 1
c. 2 or more
Roofing 8. Soffit vents in the horizontal roof overhangs from the exterior walls:
  a. None (includes if there are no overhang soffits)
b. 4-8
c. >8
Roofing 9. Upper roof vents on or near the top ridge:
  a. Ridge vent only across the top horizontal edge
b. Mushroom vents near the ridge
c. Both mushroom vents and ridge vent
d. Gable vents only - on the vertical gable ends of the roof
e. Gable vents and upper vents (mushroom or ridge vent)
Exterior Drainage 1. Gutters and downspouts:
  a. Yes
b. No
Exterior Drainage 2. Gutters pitch toward downspouts? (If only one is wrong, answer No)
  a. Yes
b. No
Exterior Drainage 3. Gutter conditions:
  a. Rusted with holes and openings
b. Open junctions and some gutters hang away from the fascia wall
c. Conditions are OK
Exterior Drainage 4. Downspouts:
  a. 1 missing
b. 2 missing
c. >2 missing
d. None
Exterior Drainage 5. Downspout extensions:
  a. None
b. Up to 1 foot out
c. 1-3 feet out
d. >3 feet out
Exterior Drainage 6a. If downspouts go into the ground, do they drain out to a lower point in the yard
  a. Yes
b. No
c. Unknown
Exterior Drainage 6b. If downspouts go into the ground, do they connect to a municipal sewer?
  a. Yes
b. No
c. Unknown
Exterior Drainage 7a. Soils at the foundation of the home: Are soils negatively pitched at any extensive areas at the foundation wall?
  a. Yes
b. No
Exterior Drainage 7b. If Yes, is the pitch(slope) toward the foundation in any area approximately:
  a. 5-10% negative (slight)
b. 10-25% negative (moderate)
c. 25-50% negative (heavy)
d. >50% negative (extreme)
Topography 1. Is home close to a pond/lake/river?
  a. Yes
b. No
Topography 2. Is the home near the bottom of a hill or hills?
  a. Yes
b. No
Topography 3. Does the land on sides, front and back of the home slope toward the home?
  a. 1 side
b. 2 sides
c. 3 sides
d. >3 sides
Interior Drainage 1. Is there a sump pit in the floor of the basement or crawl space with an operating pump in it?
  a. Yes
b. No
Interior Drainage 2. If yes, are there circular drain holes visible down in the side perimeter wall of the pit?
  a. Yes
b. No
Interior Drainage 3. Is there a back flow preventer valve present on the PVC discharge pipe above the sump pump?
  a. Yes
b. No
Interior Drainage 4. Is the sump pit covered?
  a. Yes
b. No
Interior Drainage 5. Is the sump pit in a closet?
  a. Yes
b. No
Interior Drainage 6. If there is a sump pump, is the length of the discharge pipe on the exterior?
  a. 1 foot or less
b. 1-2 feet
c. 3 feet or more
Interior Drainage 7. If there is an ejector pit in the floor, is it uncovered?
  a. Yes
b. No
Interior Drainage 8. If there are window wells in the basement walls, are drains visible on the floors of the window wells?
  a. Yes
b. No
Interior Drainage 9. Are there cracks in the concrete walls of the basement or crawl space, that have a white powdery material or dried water stains on the concrete?
  a. Yes
b. No
HVAC 1. What type of heating system?
  a. Forced Air
b. Hot water (Hydronic)
c. Steam
d. Electric
HVAC 2. If the foundation is a concrete slab, is there ductwork in the slab itself?
  a. Yes
b. No
HVAC 3. If the system is forced air, is it a higher efficiency system that brings in combustion air through a PVC pipe into the furnace from the outside?
  a. Yes
b. No
HVAC 4. Is there a furnace in an attic space or upstairs closet?
  a. Yes
b. No
HVAC 5. If yes, are there PVC Pipes from the attic furnace going to the outdoors?
  a. Yes
b. No
HVAC 6. If yes to question #4, is there a water catch pan under the furnace?
  a. Yes
b. No
HVAC 7. If yes, is there an electrical warning sign switch attached in the water catch pan?
  a. Yes
b. No
HVAC 8. Is there a humidifier attached to the furnace?
  a. Yes
b. No
HVAC 9. Is there central air on furnace?
  a. Yes
b. No
HVAC 10. Does the air conditioning and/or humidifier condensate drain terminate properly at a drain?
  a. Yes
b. No
HVAC 11. Are visible ductwork and plenum junctions that are visible properly sealed with heat sensitive silver tape?
  a. Yes
b. No
Plumbing 1. Type of water supply lines:
  a. Copper
b. Iron
c. PVC/Plastic
d. A combination
Plumbing 2. Is there heavy oxidation or build up at junctions of pipes? (usually green or white)
  a. Yes
b. No
Plumbing 3. Overhead sewer drains? (Usually wide black cast iron pipes, drain from home exits through a foundation wall)
  a. Yes
b. No
Plumbing 4a. Condition of bath/shower surrounds (re: one or more baths has conditions) Are tile walls soft and can be pushed slightly?
  a. Yes
b. No
Plumbing 4b. Condition of bath/shower surrounds (re: one or more baths has conditions) Are there any loose or missing tiles on walls?
  a. Yes
b. No
Plumbing 5a. Floor condition by toilets, are there visible stains and/or moisture?
  a. Yes
b. No
Plumbing 5b. Floor condition by toilets, is there any damaged wood trim behind toilet or vanity next to toilet?
  a. Yes
b. No
Plumbing 6. Water damage/mold under kitchen sink:
  a. Yes
b. No
Plumbing 7. Water damage/mold under bath vanities:
  a. Yes
b. No
Foundation 1. Is There a Full Basement:
  a. Yes
b. No
Foundation 2. If So, Is The Basement Finished?
  a. Yes
b. No
Foundation 3. Is There Carpeting on the Basement Floor
  a. Yes
b. No
Foundation 4. Is the foundation a concrete slab?
  a. Yes
b. No
Foundation 5. If a slab, are there water line heating pipes in the slab?
  a. Yes
b. No
Foundation 6. Is the basement a partial basement + crawl space?
  a. Yes
b. No
Foundation 7. Is the foundation all crawl space? (If not go to question #9)
  a. Yes
b. No
Foundation 8. If a crawl space, is the floor of it:
  a. Uncovered soil
b. Gravel covered soil
c. Plastic cover over soil/stones
d. Concrete
Foundation 9. If the answer of #7 above is plastic, is the plastic?
  a. Thin loose unsealed plastic
b. Heavy gauge sealed plastic
Foundation 10. Number of visible cracks in walls of foundation?
  a. 0
b. 1-2
c. 2-4
d. >4
Foundation 11. Is there evidence of past flooding such as rust at the bottom of steel posts, water marks on walls, dried water stains on materials, rusted nails, etc.?
  a. Yes
b. No
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