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Housing Quality Standards Report Template

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Housing Quality Standards Report Template

Requirements

Name of family
Tenant ID Number
Date of Request (mm/dd/yyyy)
Inspector name

Living Room

Living Room Present
Electricity
Electrical Hazards
Security
Window Condition
Celling Condition
Wall Condition
Floor Condition
Lead-Based Paint
Are all the painted surfaces free of deteriorated paint?

Kitchen

Kitchen Area Present
Electricity
Electrical Hazards
Security
Window Condition
Ceiling Condition
Wall Condition
Floor Condition
Stove or Range with Oven
Refrigerator
Sink
Space for Storage, Preparation, and Serving of Food
Lead-Based Paint
Are the painted surfaces free of deteriorated paint?

Bathroom

Bathroom Present
Electricity
Electrical Hazards
Security
Window Condition
Ceiling Condition
Wall Condition
Floor Condition
Flush Toilet in Enclosed Room in Unit
Fixed Wash Basin or Lavatory in Unit
Tub or Shower in Unit
Ventilation
Lead-Based Paint
Are the painted surfaces free of deteriorated paint?

Other Rooms Used For Living and Halls

Room Code and Room Location
Electricity/Illumination
Electrical Hazards
Security
Window Condition
Lead-Based Paint
Are all painted surfaces free of deteriorated paint?
Ceiling Condition
Wall Condition
Floor Condition

Other Rooms Used For Living and Halls

Room Code and Room Location
Electricity/Illumination
Electrical Hazards
Security
Window Condition
Wall Condition
Ceiling Condition
Floor Condition
Lead-Based Paint
Are all painted surfaces free of deteriorated paint?

All Secondary Rooms (Rooms not used for Living)

Security
Electrical Hazards
Other Potentially Hazardous Features in these Rooms

Building Exterior

Condition of Foundation
Condition of Stairs, Rails, and Porches
Condition of Roof/Gutters
Condition of Exterior Surfaces
Condition of Chimney
Manufactured Home: Tie Downs
Are all painted surfaces free of deteriorated paint?
Lead Paint: Exterior Surfaces

Heating and Plumbing

Adequacy of Heating Equipment
Safety of Heating Equipment
Ventilation/Cooling
Water Heater
Approvable Water Supply
Plumbing
Sewer Connection

General Health and Safety

Access to Unit
Fire Exits
Evidence of Infestation
Garbage and Debris
Refuse Disposal
Interior Stairs and Commom Halls
Other Interior Hazards
Elevators

Inspection Summary/Comments

Tenant ID Number
Inspection
Date of inspection
Comments
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