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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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