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Housing Quality Standards Report Template

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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
annotation!!!
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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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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