Nightingale

Section 2

HEALTHY HOMES VISUAL ASSESSMENT DATA COLLECTION FORM

The Healthy Homes Visual Assessment Data Collection Form is a tool that can be adapted by local jurisdictions to meet their specific needs.

The visual assessment should be used to collect information that can be determined without asking questions of a resident. Information that cannot be determined visually should be collected on the Healthy Homes Model Resident Questionnaire (Section 1).

The visual assessment form and accompanying description of health and safety conditions (Appendix 1) are adapted from the HUD Public Housing Assessment System (PHAS) and its Physical Assessment Subsystem (PASS) as well as from inspection protocols used by HUD healthy homes program grantees.

Date of Assessment

_________________September 15, 2017_______________________

Building and/or Unit Street Address

_______________2000 Ulster Gardens Court____________________

City/State/Zip Code

___________________ Ulster, NY 12401_____________________________

Name of Data Collector

___________________ ________________________

Signature

_________________ _____________________________

WEATHER CONDITIONS:

Dry Rain today or recently Snow today or recently

Temperature: ___85______°F

FRONT DOOR OF UNIT FACES:

North South East West

TYPE OF UNIT BEING ASSESSED:

Single-family Duplex Triplex Fourplex

Townhome Low-rise High-rise Other

(1–3 floors) (4+ floors)

UNIT STATUS:

Occupied Vacant

INSTRUCTIONS FOR VISUAL ASSESSMENT OBSERVATIONS

• Select only one answer per question. If more than one answer is possible, record the most severe hazard and note the others in the comments section at the end of each section.

• Complete one set of “site” observations for each building or housing development.

• Complete one set of “exterior and building system” observations for each building.

• Complete one set of “common area” observations for each building. Do not complete the common area section if no common area exists.

• Complete one set of “unit” and “other” observations for each housing unit inspected.

• Document deviations from inspection protocol in the comments section space (e.g., units not available for inspection)

• Specific locations of specific hazards can be recorded in the comments section if desired.

For each assessment item, bolded responses indicate areas of greater concern. Imminent health and safety hazards appear in red.

Each response is defined. There is one response for each item. For descriptions of health and safety conditions and cross references to the 2003 IPMC, see Appendix 1.

This inspection protocol does not establish legal and/or complete compliance with local, state, federal or other applicable housing, building, health, safety or other applicable policies, codes, regulations, statutes and laws.

MAJOR VISUAL ASSESSMENT AREAS

Site (Items 1–29)..............................................................................................................4

Building Exterior (Items 30–62)......................................................................................13

Building Systems (Items 63–81).....................................................................................24

Common Areas (Items 82–102)......................................................................................30

Housing Unit (Items 103–196)........................................................................................40

Other Items (Items 197–229)..........................................................................................66

SITE (ITEMS 1–29)

Items to inspect in this category are

• Fencing and Gates

• Grounds or Pavement

• Children’s Play Areas

• Other

A comment area for the site category is also included in this section.

FENCING AND GATES

Site 1. Damaged/Falling/Leaning/Deteriorated Paint

Damaged but not functional or deteriorated paint in an area larger than 20 square feet: An exterior fence or gate is so damaged that it does not function as it should. An exterior fence, security fence, or gate is damaged and does not function as it should or could threaten safety or security.

No fencing or gates present

Damaged but functional; no deteriorated paint areas larger than 20 square feet: An exterior fence, security fence, or gate shows signs of deterioration, but still functions as it should, and it presents no risk to security or safety

No damage

Site 2. Holes or Openings in Soil Below Fence

≥6 square inches

<6 square inches

No holes or not applicable

GROUNDS OR PAVEMENT

Site 3. Areas of Erosion

 Large erosion (depression, rut or groove more than 8 inches wide by 5 inches deep): Runoff has extensively displaced soil, which has caused visible damage to structures

-OR-Advanced erosion threatens the safety of pedestrians or makes an area of the grounds unusable

-OR-There is a rut larger than 8 inches wide by 5 inches deep

-OR-There is extensive ponding

-OR-Water or ice has collected in a depression or on ground where ponding was not intended

 Pooling of water (small erosion; depression, rut or groove less than 8 inches wide by 5 inches deep): Erosion has caused surface material to collect, leading to a degraded surface that would likely cause water to pool in a confined area, especially next to structures, paved areas, or walkways, or a small rut/groove is 6–8 inches wide and 3–5 inches deep

No erosion

Site 4. Overgrown Vegetation

 Vegetation has damaged building. Plants have visibly damaged a component, area, or system of the property or have made them unusable/impassable. Vegetation is extensive and dense; it is difficult to see broken glass, holes, and other hazards.

-OR-Vegetation penetrates an unintended surface—buildings; gutters; fences/walls; roofs; heating, ventilation, and air conditioning units (HVAC); etc.

-OR-Vegetation is producing excessive moisture that may lead to mold or mildew on nearby exterior building surface

-OR-Tree is in danger of falling

 Vegetation is present or contacts building, but no damage: Extensive, dense vegetation obstructs the intended path of walkways or roads, but the path is still passable

-OR-Vegetation is present but causes no problem

 No vegetation present

Site 5. Graffiti

 6 or more places: Graffiti in 6 or more places  2–5 places: Graffiti in 2–5 places

 One place: Graffiti in one place

 No graffiti

Site 6. Litter

 Excessive: More than 10 large trash or litter items

 Slight or Moderate: 2–10 large trash or litter items

 None: Fewer than 2 large trash or litter items

Site 7. Cracks in Pavement

 ≥ ¾ inch, hinging/tilting, or missing section(s) that affect traffic ability over more than 5% of the property’s parking lots/driveways/roads or that cause trip hazards: major trip hazard  <¾ inch displacement (vertical height): minor trip hazard  No cracks: level

Site 8. Fire Ants/Mounds or Harmful Insects

 Yes: Presence of fire ants/mounds or harmful insects

 No: Fire ants/mounds or harmful insects not seen

Site 9. Containers That Hold Water

 Yes: Presence of water-holding containers conducive to mosquito breeding

 No: Water-holding containers not present

CHILDREN’S PLAY AREAS

Site 10. Equipment

Equipment that poses an immediate threat: REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION  ≥50% of surface area broken/damaged: Most of the equipment (50% or more) does not operate as it should, but poses no safety risk  <50% of surface area broken/damaged: Less than half of the equipment does not operate as it should, but poses no safety risk  No play equipment observed (skip to Site 21)

Site 11. Paint Condition

 Deteriorated paint on ≥50% of surface area of play area equipment  Deteriorated paint on <50% of surface area of play area equipment -OR-No deteriorated paint on play area equipment

Site 12. Bare Soil

 ≥9 square feet of bare soil present in play area  <9 square feet of bare soil present in play area

Site 13. Injury-absorbent Surface Depth

 No: No injury-absorbent surface under playground equipment or injury-absorbent surface depth less than 12 inches  Yes: Injury-absorbent surface under playground equipment at proper depth (at least 12 inches)

13b. Surface type: ________________________________________________

Site 14. Deteriorated Injury-absorbent Surface

 Yes: Injury-absorbent surface ≥50% deteriorated

Yes: Injury-absorbent surface <50% deteriorated

No deterioration

Site 15. Fencing and Gates

 Damaged, not functional: An interior fence or gate is so damaged that it does not function as it should. An exterior fence, security fence, or gate is damaged and does not function as it should or could threaten safety or security.

 Damaged, but functional: An exterior fence, security fence, or gate shows signs of deterioration, but still functions as it should, and it presents no risk to security or safety

 No damage

 No play area fencing/gates

Site 16. Condition

 Refuse, animal feces, broken glass/sharp edges, or holes/trip hazards observed

 No refuse, animal feces, broken glass/sharp edges, or holes/trip hazards observed

Site 17. Exposed Bolts

 Yes: Exposed bolts are found on the playground equipment

 No: Playground equipment does not have exposed bolts

Site 18. Hanging or Choking Hazards

Yes: Hanging and/or choking hazards on playground equipment

 No: No hanging and/or choking hazards present on playground equipment

Site 19. Open “S” Hooks

 Yes: Open “S” hooks on swings or other playground equipment

 No: No open “S” hooks on swings or other playground equipment

Site 20. Pinch Hazards

 Yes: Pinch hazards on playground equipment

 No: No pinch hazards on playground equipment

OTHER

Site 21. Refuse Disposal

 Wall or roof for outdoor enclosed area is leaning or collapsed

-OR-Concrete slab deteriorated

 Collection area overflowing: Area is too small to store refuse until pickup

-OR-Garbage cans are overflowing

 No exterior refuse disposal

 Refuse properly contained

Site 22. Retaining Walls

 Severe deterioration/safety risk: A retaining wall is damaged and does not function as it should or is a safety risk

 Some deterioration: A retaining wall shows some signs of deterioration, but it still functions as it should, and it is not a safety risk

 No deterioration

 No retaining walls present

Site 23. Standing Water

 Yes: Storm drainage areas (e.g., ditches) have standing water

 No: No standing water in storm drainage areas

NOTE: This does not include stormwater detention basins, which are addressed in Site 24 and 25.

Site 24. Storm Drainage

 Completely blocked: The system is completely blocked or a large segment of the system has failed because a large quantity of debris has caused: backups into adjacent area(s)

-OR-Runoffs into areas where runoffs are not intended

 Partially blocked: The system is partially blocked by a large quantity of debris, causing backup into adjacent area(s)

 No designed storm drainage

 No obstructions

Site 25. Outdoor Water

 Yes: Pond/lake/stream

Yes: Drainage reservoir

No: No other water on site

Site 26. Outdoor Water: Drainage Reservoir Fencing

No: Reservoir not fenced

Yes: Reservoir fenced but fence needs repair

Yes: Reservoir fully fenced and fence intact

Not applicable: No drainage reservoir

Site 27. Septic Tank

Moist ground in septic tank area: IMMINENT HEALTH HAZARD: REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION

No evidence of excessive ground moisture

No septic tank present

Site 28. Walkways/Steps/Hand Railing

Missing or damaged or loose: A hand rail for four or more stairs is missing, damaged, loose, or other​wise unusable; hand rail only present on one side, visible faults in the pavement: longitudinal, lateral, alligator, etc. -OR-Pavement that sinks or rises because of the failure of sub-base materials. Five percent or more of the walkways must be impacted—50 out of 1,000 square feet, for example. Relief joints are there by design; do not consider them cracks. When observing traffic ability, consider the capacity to support pedestrians, wheelchairs, and people using walkers. Cracks greater than ¾ inch, hinging/tilting, or missing section(s) that affect traffic ability over more than 5% of the property’s walkways/steps.

No damage

No walkway/steps

Site 29. Large Trees

Hanging over unit and touching unit

Well maintained: Trimmed back from unit

No large trees present

COMMENTS, SITE SECTION

BUILDING EXTERIOR (ITEMS 30–62)

Items to inspect in this category are

· Doors

· Fire Escapes

· Foundations

· Lighting

· Roofs

· Walls

· Windows

A comment area for the building exterior category is also included in this section.

Exterior 30. Building Access for the Disabled

 Building is not accessible for the disabled

Building is accessible for the disabled

 Not applicable (single-family unit with no disabled residents)

DOORS

Exterior 31. Damaged Frames/Threshold/Lintels/Trim

At least one fire/emergency door not working or cannot be locked because of damage to the frame, threshold, lintel, or trim. This also includes the main front door.

At least one door not working or functioning or cannot be locked because of damage to the frame, threshold, lintel, or trim

No damage

NOTE: This does not include damage to door hardware (locks, hinges, etc.), which is addressed in Exterior 32.

Exterior 32. Damaged Hardware/Locks

 One or more door’s panic hardware does not function as it should

-OR-One entry door or fire/emergency door does not function as it should or cannot be locked because of damage to the door’s hardware

 One or more doors cannot be locked and does not function as it should or cannot be locked because of damage to the door’s hardware

 No damage

Exterior 33. Damaged Surface

 ≥1 inch diameter: One door has a hole or holes larger than 1 inch in diameter, significant peeling/cracking/no paint, rust that affects the integrity of the door surface, or broken/missing glass

-OR-One entry door or fire/emergency door has a hole or holes with a diameter ranging from ¼ inch to 1 inch

 ¼ inch–1 inch diameter: One door has a hole or holes with a diameter ranging from ¼ inch to 1 inch

 No damage

Exterior 34. Screen/Storm Doors Damaged/Missing

Security door inoperable

Missing screen or glass: At least one screen door or storm door is damaged or is missing screens or glass—shown by an empty frame or frames

Missing door: There must be evidence that a screen/storm/security door existed

 No damage

Exterior 35. Deteriorated/Missing Caulking/Seals/Flashing

Missing or damaged caulk, seals, or flashing: The seals/caulking is missing on one entry door, or they are so damaged that they do not function as they should

 No missing or damaged caulk, seals, or flashing

Not designed to have seals, caulk, or flashing

Exterior 36. Missing Doors (In Exterior Doorway)

Yes: One or more doors is missing

No: All doors are present

FIRE ESCAPES

Exterior 37. Egress

Fire escape blocked or otherwise not functioning

No fire escape

Fire escape functioning and not blocked

Exterior 38. Components

Ladder, railing, stair missing (or not operational): Any of the functional components that affect the function of the fire escape (for example, one section of a ladder or a railing) are missing

No fire escape

No missing components

Exterior 39. Fire Escape/Emergency Egress

No: No fire escape for basements with bedrooms and finished living spaces

Yes: At least one fire escape for basements with bedrooms and finished living spaces

Not applicable

FOUNDATIONS

Exterior 40. Foundation Type

Slab

Crawl space

Basement

Cellar

Exterior 41. Cracks/Gaps

≥1/8 inches wide × 1/8 inches deep × 6 inches long: Cracks more than 1/8 inch wide by 1/8 inch deep by 6 inches long -OR-Large pieces—many bricks, for example—are separated or missing from the wall or floor -OR-Large cracks or gaps (a possible sign of a serious structural problem) -OR-Cracks run the full depth of the wall, providing opportunity for water penetration -OR-Sections of the wall or floor are broken apart

<1/8 inches wide × 1/8 inches deep × 6 inches long: Cracks smaller than these dimensions

No cracks/gaps: No signs of deterioration

Exterior 42. Spalling/Exposed Rebar

≥50%: Obvious, significant spalled area(s) are affecting 50% or more of any foundation wall

-OR-Spalling is exposing any reinforcing material (rebar or other material)

10 to <50%: Obvious, large spalled area(s) are affecting 10%–50% of any foundation wall

10%

Not applicable (no foundation)

LIGHTING

Exterior 43. Fixtures/Bulbs

≥20% broken/inoperable

-OR-The condition constitutes an obvious safety hazard: REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION

<20% broken/inoperable, but this does not constitute an obvious safety hazard

No exterior lighting

No broken/inoperable fixtures/bulbs

ROOFS

Exterior 44. Damaged/Clogged Drains (Roofs)

Fully clogged: Drain is so damaged or clogged with debris so the drain no longer functions (shown by ponding)

Partially clogged: Debris around or in a drain, but no evidence of ponding

-OR-Drain is damaged or partially clogged with debris, but the drain system still functions and there is no evidence of ponding

 No clog

No drain

NOTE: This does not include gutters and downspouts, which are addressed in Exterior 48.

Exterior 45. Chimney Clearance

All chimneys do not have good clearance above roof line: Chimney height is less than 3 feet above the highest point where the chimney penetrates the roofline

All chimneys have good clearance above roof line: Chimney height is more than 3 feet above the highest point where the chimney penetrates the roofline

No chimneys

Exterior 46. Damaged Soffits/Fascia/Flashing

Missing or damaged with water intrusion: Soffits or fascia that should be there are missing or so damaged that water penetration is visibly possible

Some cracks but no water intrusion: Damage to soffits or fascia, but no obvious opportunities for water penetration

No damage

Exterior 47. Vents

Missing or major damage: Vents are missing or so visibly damaged that further roof damage is possible.

Some damage: The vents are visibly damaged, but do not present an obvious risk to promote further roof damage

No damage

NOTE: This does not include exhaust fans on the roof or soffit vents, which are addressed in Building Systems 65.

Exterior 48. Gutters/Downspouts

Some components missing: Splashblocks or other components are missing. Drainage system components are missing, causing visible damage to the roof, structure, exterior wall surface, or interior.

Some components damaged: Splashblocks or other components are damaged. Drainage system components are damaged, causing visible damage to the roof, structure, exterior wall surface, or interior.

Both: Some components are missing and some are damaged

No damaged or missing

Exterior 49. Gutters/Downspout Discharge

Less than 2 feet from building foundation or grading causes water to pool near foundation

Discharges directly to storm water system

More than 2 feet from building and grading is sloped away from foundation

NOTE: This does not include clogged drains, which are addressed in Exterior 44.

Exterior 50. Shingles or Tiles or Other Roofing Material

≥100 square feet of shingle or tile damage

 One shingle to less than 100 square feet of shingle, tile, or roofing material damage

One shingle or tile missing/damaged (<1 square foot)

No missing or damaged shingles, tiles, or roofing material

WALLS

Exterior 51. Primary Exterior Wall Surfaces

Brick

Stucco

Wood

Stone

Cement/concrete block

Asbestos

Vinyl

Other: _________________

Exterior 52. Secondary Exterior Wall Surfaces

Brick

Stucco

Wood

Stone

Cement/concrete block

Asbestos

Vinyl

Other: _________________

Not applicable

Exterior 53. Wall Cracks and Gaps

≥1/8 inches wide × 1/8 inches deep × 6 inches long: Crack(s) more than 1/8 inch wide by 1/8 inch deep by 6 inches long

-OR-evidence of moisture intrusion

-OR-Pieces—many bricks, for example—are separated from the wall

-OR-Crack(s) run the full depth of the wall, providing opportunity for water penetration

-OR-Sections of the wall are broken apart

<1/8 inches wide × 1/8 inches deep × 6 inches long: Crack(s) less than 1/8 inch wide by 1/8 inch deep by 6 inches long and no evidence of moisture intrusion

No cracks/gaps

Exterior 54. Damaged Chimney

Chimney separated from wall

 Holes >4 inches × 4 inches: The surface of the chimney shows surface damage on more than one piece of wall—a few bricks or a section of siding, for example

-OR-The surface of the chimney has holes that affect an area larger than 4 inches by 4 inches

 Both holes and separation

Holes observed, total area of opening <4 inches × 4 inches

No damage or no chimney required

Exterior 55. Wall Surface Deterioration

≥8½ × 11 inches: A missing piece—a single brick or section of siding, for example—or a hole larger than ½ inch in diameter

-OR-Deterioration affects an area larger than 8½ inches by 11 inches

-OR-Deterioration exposes any reinforcing material (rebar)

-OR-There is a hole of any size that completely penetrates the exterior wall

-OR-Wall surfaces out of plumb (≥1 inch in 20 feet)

-OR-Wall surface out of horizontal alignment (≥1 inch in 20 feet)

Up to 8½ inches × 11 inches: A missing piece—a single brick or section of siding, for example—or a hole smaller than ½ inch in diameter

-OR-Deterioration affects an area up to 8½ inches by 11 inches

No missing pieces/holes/spalling

Exterior 56. Masonry Caulking and/or Mortar

≥12 inches missing/damaged: Mortar is missing around more than one contiguous masonry unit

-OR-Deteriorated caulking in an area longer than 12 inches

<12 inches missing/damaged: Mortar is missing around a single masonry unit

-OR-Deteriorated caulk is confined to less than 12 inches

No damage or no caulking/mortar

Exterior 57. Wall/Soffit/Fascia Paint/Water Damage

≥20 square feet: More than 20 square feet of building exterior walls affected

<20 square feet, but some staining: Less than 20 square feet of building exterior walls affected

No water stains/peeling or no paint required (e.g., brick walls)

WINDOWS

Exterior 58. Window Panes

One or more missing or broken: A glass pane is missing

-OR-A glass pane is cracked or broken AND sharp edges are seen

Both broken and missing: More than one window has broken and missing glass panes

 One or more cracked: A glass pane is cracked but no sharp edges are seen

None broken, cracked, or missing

Exterior 59. Screens

1 or more screens damaged: One or more screens in one building are punctured, torn, or otherwise damaged

1 or more screens missing: Do not cite this if the window is not designed to have a screen

Both damaged and missing: One or more screen damaged or missing

No screens damaged or missing or no screen required

Exterior 60. Sills/Frames/Lintels/Trim

Major damage, missing or exposed interior wall, not weathertight: Sills, frames, lintels, or trim are missing or damaged, exposing the inside of the surrounding walls and compromising its weather tightness

Some damage, but no wall exposed, still weathertight: Damage to sills, frames, lintels, or trim, but nothing is missing. The inside of the surrounding wall is not exposed. No impact seen on either the functioning of the window or weather tightness.

No damage

Exterior 61. Caulking/Seals/Glazing Compound

Missing or deteriorated, leaks or damage present: There are missing or deteriorated caulk or seals—with evidence of leaks or damage to the window or surrounding structure

Missing/deteriorated, but no leaks or damage: Most of the window shows missing or deteriorated caulk or glazing compound, but there is no evidence of damage to the window or surrounding structure or leaks

Not missing or deteriorated

Exterior 62. Window Assembly or Trim Paint

≥50%: Peeling paint or a window that needs paint on more than 50% of the painted surface

10% to <50%: Peeling paint or a window that needs paint on between 10%–50% of the painted surface

<10%, but some non-intact: Peeling paint or a window that needs paint on less than 10% of the painted surface

All intact: All paint on exterior windows is intact or no paint is required (e.g., aluminum or vinyl windows)

COMMENTS, EXTERIOR SECTION

Building Systems (Items 63–81)

Note: This section is for multihome sites only. If this is a single-family home, skip to Item 103.

Items to inspect in this category include

• Electrical systems

• Fire protection

• HVAC

A comment area for the building systems category is also included in this section.

Building Systems 63. Central Water Supply or Sewage System

Water leaks observed: If leaking water is a safety concern (i.e., is leaking on or near electrical equipment), REPORT IT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION

No water leaks observed

Building Systems 64. Outside Water Spigots

Outside water spigots protected by hose Bibb vacuum breakers

Outside water spigots not protected by hose Bibb vacuum breakers

Building Systems 65. Chimney and Exhaust Ventilation for Fuel-fired Equipment

Improper exhaust venting: Any misalignment, blockage, rust, corrosion, or other deficiency that may cause improper or dangerous venting of exhaust gases

-OR-There is no pressure relief valve

Proper exhaust venting: flue ok

No chimney exhaust ventilation system required (e.g., electric water heater)

Building Systems 66. Makeup Air

Makeup air not provided to the fireplace, gas water heater, or other fuel-burning fixtures

Makeup air provided to the fireplace, gas water heater, or other fuel-burning fixtures

ELECTRICAL SYSTEMS

Building Systems 67. Breakers/Fuses

Damaged breakers or fuses, frayed wiring, arcing scars: Carbon residue, melted breakers, or arcing scars

Missing breakers/open panels/missing covers: Missing breakers or open panels (breaker port or receptacle or panel cover)

Improper fusing: Fuse receptacles with improper fuses or bypassed

Access blocked; could not inspect: The electrical system could not be visually accessed because of blockage or inaccessibility

No deficiency observed

NOTE: Do not attempt to disassemble any electrical component or touch any circuit.

Building Systems 68. Water Leaks or Corrosion On or Near Electrical Systems

Evidence of water leaks/corrosion: Any corrosion that affects the condition of the components that carry current

-OR-Any stains or rust on the interior of electrical enclosures

-OR-Any evidence of water leaks in the enclosure or hardware

No evidence of water leaks/corrosion

Building Systems 69. Wiring

Deteriorated insulation exposing conducting wire: Nicks, abrasions, or fraying of the insulation exposing any conducting wire. Do not check this for a bare grounding wire.

No deteriorated insulation

Building Systems 70. Extension Cord Use

Extension cords not used properly: Extension cords under carpets or across doorways

-OR-Too many appliances plugged into one extension cord

Extension cords used properly: Extension cords not draped across doorways or under carpets and not overloaded with too many appliances

No extension cord use

Building Systems 71. Extension Cord Condition

Not good: Extension cords cracked or frayed

Good: Extension cords not cracked or frayed

No extension cord use

Building Systems 72. Electrical Covers

One or more missing covers: A cover is missing, which results in exposed visible electrical connections

Covers not missing

FIRE PROTECTION

Building Systems 73. Fire Sprinklers

Sprinkler disabled, missing, blocked, or painted over: Any sprinkler head is missing, visibly disabled, painted over, blocked, capped or otherwise disabled. REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION.

No sprinkler system

Sprinkler not disabled/missing/blocked

Building Systems 74. Missing, Damaged, Expired, or Wrong Kind of Fire Extinguishers/Fire Hoses

≥10%, or none in building: More than 10% of the fire extinguishers are missing, damaged, or expired. IF THERE ARE NO FIRE EXTINGUISHERS, REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION.

-OR-There is not an operable/non-expired fire extinguisher on each floor

-OR-The building does not have a fire extinguisher

≥5% to <10%: 5%–10% of the fire extinguishers are missing, damaged, expired, or wrong kind

<1% to <5%: <1% to <5% of extinguishers missing/damaged/expired or wrong kind

None missing/damaged/expired

Building Systems 75. Emergency Exit/Egress Routes

All exits not clear of furniture, toys, and clutter

All exits clear of furniture, toys, and clutter

HVAC

Building Systems 76. Boiler/Pump

Water or steam leaks: Water or steam leaking in piping or pump packing or boiler

No leaks

Does not apply

NOTE: This does not include fuel supply leaks, which are addressed in Building Systems 77.

Building Systems 77. Fuel Supply

Leaks observed or odor of natural gas, propane, or oil detected: Any amount of fuel is leaking from the supply tank or piping. REPORT LEAKS TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION. THE ODOR OF NATURAL GAS OR PROPANE IS AN IMMINENT HEALT HAZARD; THE STRUCTURE SHOULD BE EVACUATED.

No leaks observed or odor detected

Does not apply

Building Systems 78. Chimney Exhaust

Reversed air flow in chimney observed. REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION.

Misaligned, damaged, blocked, or disconnected: Misalignment of an exhaust system on a gas-fired or oil-fired unit that causes improper or dangerous venting of gases

-OR-Evidence of blockage or disconnection

-OR-Evidence of rust and corrosion that could cause improper flue pipe and chimney function

Not misaligned, damaged, blocked, or disconnected

No chimney exhaust ventilation required

Building Systems 79. Chimney Spark Arrestor and Rain Cap

No chimney spark arrestor or rain cap

Chimney spark arrestor and rain cap installed

No chimney

Building Systems 80. HVAC Condensate and Sewage Corrosion

Rust or corrosion prevents functioning: Significant formations of metal oxides, significant flaking, discoloration, or the development of a noticeable pit or crevice

-OR-Equipment or piping does not function because of this condition

-OR-A drain is clogged or components of the sanitary system are leaking.

-OR-Evidence of standing water, puddles, or ponding (a sign of leaks or clogged drains)

Some rust or corrosion or other damage, but system functioning

No rust/corrosion

Not applicable: No ducts or pipes

Building Systems 81. HVAC Air Supply

From basement only

Supply (return) air entirely from living area

Supply (return) air includes fresh (outdoor) air

No forced air system present

COMMENTS, BUILDING SYSTEMS SECTION

Common Areas (Items 82–102)

NOTE: This section is for multihome sites only. If this is a single-family home, skip to Item 103.

Items to inspect in this category include

• Walkways/steps

• Ceilings

• Floors

A comment area for the common areas category is also included in this section.

ELEVATORS

Common Areas 82. Elevators

Elevators and elevator equipment do not work properly

Elevators and elevator equipment work properly

No elevators

SIGNAGE

Common Areas 83. Exit Signage

Exit signs missing or broken or not visible

Exit signs present and functioning

SMOKING AREA

Common Areas 84. Designated Smoking Area

Area littered with butts/food debris

No butts/food debris observed

No designated smoking area

INTERIOR TRASH

Common Areas 85. Trash Collection Areas

Trash on floor: Extensive trash and/or garbage on the floor

Trash containers/chutes missing covers: Missing or damaged covers to trash chutes or trash or garbage containers

Both: Both trash on floor and missing or damaged covers

No trash on floor or missing covers

OUTLETS, SWITCHES, COVER PLATES

Common Areas 86. Electrical Outlets

Exposed wiring

Missing cover plates

Both: Both exposed wiring and missing cover plates

No exposed wiring or missing cover plates

SMOKE AND CARBON MONOXIDE DETECTORS

Common Areas 87. Smoke Detectors

Not operational: One smoke detector tested per inspected common area; detector does not work as designed

No smoke detector: No smoke detectors in common area

Operational: One smoke detector tested per inspected common area; detector works as designed

Note: Test one per inspected common area if feasible.

Common Areas 88. Carbon Monoxide Detectors

Not operational: One CO detector tested per inspected common area; detector does not work as designed

No carbon monoxide detector: No CO detectors in common area

Operational: One CO detector tested per inspected common area; detector works as designed

Note: Test one per inspected common area if feasible.

WALKWAYS/STEPS

Common Areas 89. Walkways/Steps

Missing/damaged/loose: Walkways and steps have missing surfaces or are otherwise damaged

-OR-A missing or loose handrailing

No damage

No walkway/steps

Ceiling

Common Areas 90. Ceiling Buckling

Bulging or buckling: Bulging, buckling, sagging, or a lack of horizontal alignment

No bulging/buckling

Common Areas 91. Ceiling Holes

Large holes: Total area larger than 8½ inches × 11 inches

-OR-A hole penetrates the area above

-OR-More than three tiles or panels are missing

Small holes: Total area not larger than 8½ inches × 11 inches

-OR-No hole penetrates the area above

-OR-No more than three tiles or panels are missing

No holes observed

Common Areas 92. Peeling/Needs Paint

≥2 square feet: More than 2 square feet of peeling or deteriorated paint in one or more common areas

<2 square feet: Less than 2 square feet of peeling or deteriorated paint in one or more common areas

All intact: All paint intact

Common Areas 93. Water Stains/Water Damage

≥2 square feet: One or more ceilings(s) has evidence of a leak, water damage, or water staining (such as a darkened area) over a large area (more than 4 square feet)

<2 square feet: One or more ceiling(s) has evidence of a leak, water damage, or water staining (such as a darkened area) over a small area (less than 4 square feet)

No water stains/water damage

NOTE: This does not include visible mold on ceiling, which is addressed in Common Areas 94.

Common Areas 94. Mold

≥4 square feet mold observed or musty odor detected: On one or more ceilings(s), mold is seen in a large area (more than 4 square feet) or there is a musty odor

<4 square feet visible mold: On one or more ceiling(s), mold is seen in a small area (less than 4 square feet)

No mold or musty odor

NOTE: This does not include water stains or damage on ceiling, which is addressed in Common Areas 93.

Common Areas 95. Mold Source

Leaking roof

Leaking appliance

Leaking water pipe in wall or ceiling

Poor ventilation

Do not know

Floors

Common Areas 96. Floor Buckling

Yes: Bulging, buckling, sagging, or alignment problem

No: Bulging, buckling, sagging, or alignment problem

Common Areas 97. Floor Covering

≥50% damaged: For one or more floor(s), more than 50% of the floor covering is damaged

-OR-Damage to the floor covering exposes the underlying material

10%–<50% damaged: An estimated 10%–50% of the floor covering has stains, surface burns, shallow cuts, small holes, tears, loose areas, exposed seams, or other defect. The covering is fully functional, and there is no safety hazard.

<10% damaged: Less than 10% of the floor covering has stains, surface burns, shallow cuts, small holes, tears, loose areas, exposed seams, or other defect. The covering is fully functional, and there is no safety hazard.

No damage observed on any of the floors

Common Areas 98. Flooring/Tiles

≥50% missing or damaged: More than 50% of the flooring is affected by small holes and damage.

-OR-The condition causes a safety problem

10%–<50% missing or damaged: An estimated 10%–50% of the flooring has small holes in areas of the floor surface, but there are no safety problems

<10% missing or damaged: For a single floor, there are small holes in areas of the floor surface. Less than 10% of the floor is affected and there are no safety problems.

No damaged or missing flooring

Common Areas 99. Peeling or Deteriorated Paint

≥2 square feet: Peeling or deteriorated paint in an area larger than 2 square feet in any one room or common area

<2 square feet: Peeling or deteriorated paint in an area smaller than 2 square feet in any one room or common area

No peeling or deteriorated paint

Common Areas 100. Subfloor

≥4 square feet rotting or deteriorated: Large areas of rot (more than 4 square feet) seen

-OR-Applying weight to the floor causes noticeable deflection

<4 square feet rotting or deteriorated

Subfloor cannot be observed

Common Areas 101. Waters Stains/Water Damage

≥4 square feet: A large portion of one of more floors (more than 4 square feet) has been substantially saturated or damaged by water, mold, or mildew. Cracks, mold, and flaking are seen; the floor surface may have failed.

<4 square feet: Evidence of a water stain (such as a darkened area) over a small area of floor (less than 4 square feet). Water may or may not be seen. Less than 10% of the floors are affected.

No water stains/water damage

NOTE: This does not include visible mold on floor, which is addressed in Common Areas 102.

Common Areas 102. Mold

≥4 square feet mold observed or musty odor detected: On one or more floor(s) there is evidence of mold over a large area (more than 4 square feet)

-OR-A musty odor is detected

<4 square feet visible mold: On one or more floor(s) there is evidence of mold over a small area (less than 4 square feet)

No visible mold present

NOTE: This does not include water stains or damage on floor, which is addressed in Common Areas 101.

COMMENTS, COMMON AREAS SECTION

Housing Unit (Items 103–196)

Items to inspect in this area are

· Bathroom

· Ceiling, floors, and walls

· Doors

· Electrical

· Water heater

· HVAC system

· Kitchen

· Laundry area

· Lighting

· Patio/porch/deck/balcony

· Smoke and carbon monoxide detectors

· Stairs

· Windows

A comment area for the housing unit category is included in this section.

BATHROOM

Housing Unit 103. Bathroom Cabinets

Damaged: Shelves, vanity tops, or drawers damaged or doors not functioning as they should

Missing: Shelves, vanity tops, drawers, or doors missing

Both: Both damaged and missing elements seen

No damage/missing cabinets

Housing Unit 104. Lavatory Sink

≥50% discoloration or cracks: The sink cannot be used because of extensive discoloration or cracks

-OR-The sink or associated hardware is missing or has failed

<50% discoloration or cracks: The sink can be used, but there are either cracks or extensive discoloration affecting less than 50% of the basin

-OR-A stopper is missing

No cracks/discoloration

NOTE: This does not include clogged drains, which are addressed in Housing Unit 105.

Housing Unit 105. Plumbing Drain

Drain completely clogged: Fixtures are not usable because the drain is completely clogged or shows extensive deterioration

Slow drain: Water does not drain freely, but the fixtures can be used

Drain working properly

Housing Unit 106. Plumbing Faucets/Fixtures

Large water leak: There is a steady leak adversely affecting the area around it

-OR-The faucet or pipe cannot be used

Small water leak: There is a leak or drip contained by the basin

No leaks observed

Housing Unit 107. Water Temperature

Only hot water present, but not hotter than 120°F

Only cold water present

Hot and cold water present

Housing Unit 108. Water Pressure

Inadequate at any bathroom plumbing fixtures

Adequate at all bathroom plumbing fixtures

Housing Unit 109. Shower/Tub Surface

≥50% or surface area damaged, inoperable or missing: The shower or tub can be used but there are cracks or extensive discoloration in more than 50% of the basin surface area

-OR-The shower or tub cannot be used for any reason

-OR-The shower, tub, faucets, drains, or associated hardware are missing or have failed

<50% of surface area damaged: The shower or tub can be used but there are cracks or extensive discoloration in less than 50% of the surface area of the basin or stall

No damage

NOTE: This does not include leaking faucets or pipes, which are addressed in Housing Unit 106.

Housing Unit 110. Shower/Tub Grab Bars

Grab bars not installed

Grab bars improperly installed

Grab bars properly installed inside and outside of tub

NOTE: Applies to households with elderly residents or a resident with a physical handicap.

Housing Unit 111. Bathroom Exhaust

Exhaust fan not working

-OR-No exhaust fan or window present

Exhaust fan working

Housing Unit 112. Toilet

Toilet seat and/or bowl cracked or broken: Fixture elements (seat, flush handle, cover, etc.) are missing or damaged

-OR-There is a hazardous condition: REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION

-OR-The bowl is fractured or broken and cannot retain water

-OR-The water closet/toilet is missing

-OR-The water closet/toilet cannot be flushed because of obstruction or another defect

Toilet seat cracked or broken

Not cracked or broken: A water closet/toilet is not damaged and functions properly

Housing Unit 113. Toilet Grab Bars

Grab bars not installed

Grab bars improperly installed

Grab bars properly installed next to toilet

NOTE: Applies to households with elderly residents or a resident with a physical handicap.

Housing Unit 114. Shower/Bath/Toilet Caulking and/or Seals

Deteriorated caulk/seals

No deterioration observed

Housing Unit 115. Bathroom Call-for-Aid

Damaged or not working

Missing

No call-for-aid unit

No damage/working/not missing

NOTE: Applies to households with elderly residents or a resident with a physical handicap.

Housing Unit 116. Permanent Carpet on Bathroom Floor

Permanent carpet: Does not include removable bath mats

No permanent carpet: Bathroom floor is a hard, cleanable surface

CEILING, FLOORS, AND WALLS

Housing Unit 117. Bulging/Buckling

Bulging, buckling, or alignment problem: Bulging, buckling, sagging, or alignment problem.

No bulging, buckling, or alignment problem

Housing Unit 118. Holes

Large holes ≥8½ inches × 11 inches: A hole is larger 8½ inches by 11 inches but it does not penetrate the area above or adjacent

-OR-More than three tiles or panels are missing

-OR-There is a crack more than 1/8 inch wide and 11 inches long

-OR-A hole penetrates the area above or adjacent

Medium-sized holes present: Holes less than 8½ inches × 11 inches in area

-OR-No hole penetrates the area above or adjacent

-OR-No more than three tiles or panels are missing

Small holes present: Holes smaller than 8½ inches × ½ inches (do not count pinholes) in total hole area.

No holes observed

Housing Unit 119. Peeling/Needs Paint

≥2 square feet damage: Peeling or deteriorated paint in an area larger than 2 square feet in any one room

<2 square feet damage: Peeling or deteriorated paint in an area smaller than 2 square feet in any one room

No damage/peeling paint

Housing Unit 120. Water Stains/Water Damage

≥4 square feet water stains/water damage: Any one ceiling, floor, or wall has evidence of water stains/water damage, a leak (such as a darkened area) over a large area (4 square feet or more). Water may or may not be visible.

<4 square feet water stains/water damage: Any one ceiling, floor, or wall has evidence of water stains/water damage, a leak (such as a darkened area) over a small area (less than 4 square feet). Water may or may not be visible.

No water stains/water damage

NOTE: This does not include visible mold, which is addressed in Housing Unit 122.

Housing Unit 121. Condensation on Windows

Condensation on windows, doors, walls

No condensation on windows, doors, walls

Housing Unit 122. Mold

≥4 square feet visible mold present or musty odor detected: Any one ceiling, floor, or wall has visible mold over a large area (4 square feet or more)

-OR-A musty odor is detected

<4 square feet visible mold present: Any one ceiling, floor, or wall has visible mold over a small area (less than 4 square feet)

No mold observed or musty odor detected

NOTE: This does not include water stains or damage, which are addressed in Housing Unit 120.

Housing Unit 123. Mold Source

Leaking roof

Leaking appliance

Leaking water pipe in wall or ceiling

Poor ventilation

Do not know

Doors

Housing Unit 124. Door Surface

≥1 inch: One door has a hole or holes equal to or larger than 1 inch in diameter in total surface area, significant peeling/cracking/no paint, rust that affects the integrity of the door surface, or broken/missing glass

¼ inch to 1 inch diameter: One interior door—not a bathroom or entry door—has a hole or holes or peeling cracking no paint, or rust with a diameter ranging from ¼ inch to 1 inch in total surface area

No damaged surface observed

124b. If door surface(s) are damaged, record door location ______________________________________

Housing Unit 125. Frame/Threshold/Lintel/Trim

Bathroom or entry door not working (closing, opening and/or latching): At least one bathroom door or entry door is not functioning or cannot be locked because of damage to the frame, threshold, lintel, or trim or door hardware

At least one interior door not working (closing, opening and/or latching): At least one door is not functioning or cannot be locked because of damage to the frame, threshold, lintel, or trim or hardware

Both: Both bathroom or entry door and other interior door not working

No damage observed: All doors functioning

Housing Unit 126. Seals (Entry Only)

Entry door seals deteriorated/missing: The seals are missing on one or more entry door(s), or they are so damaged that they do not function as they should

No damage observed

Housing Unit 127. Door Missing

Bathroom door missing

One or more missing (not bathroom or entry): A door is missing, but it is not a bathroom door or entry door

Entry door missing

None missing

Housing Unit 128. Deadbolt Locks

Deadbolt locks cannot be unlocked from the inside without a key

No deadbolt locks

Deadbolt locks can be unlocked from the inside without a key

Housing Unit 129. Door Lock Operation

Door locks cannot be operated by a child in an emergency

No door locks

Door locks can be operated by a child in an emergency

ELECTRICAL

Housing Unit 130. Electrical Panel Access

Yes: One or more fixed items or items of sufficient size and weight can impede access to the unit’s electrical panel during an emergency

No: Access is not impeded

Housing Unit 131. Breakers/Fuses

Damaged breakers or fuses, frayed wiring, arcing scars: Carbon residue, melted breakers, or arcing scars

Missing breakers/open panels/missing covers: Missing breakers or open panels (breaker port or receptacle or panel cover)

Improper fusing: Fuse receptacles with improper or bypassed fuses

Access blocked; could not inspect: Electrical system could not be visually accessed due to blockage or inaccessibility

No deficiency observed

NOTE: Do not attempt to disassemble any electrical component or touch any circuit.

Housing Unit 132. Water Leaks or Corrosion Near Electrical Systems

Yes: Any leaks or corrosion

-OR-Any stains or rust on the interior of electrical enclosures

-OR-Any evidence of water leaks in the enclosure or any hardware deficiency (such as nicks, abrasions, or fraying of the insulation that expose wires that conduct current).

NOTE: Do not consider this a deficiency for wires that are not intended to be insulated, such as grounding wires.

No: Leaks or corrosion not observed

Housing Unit 133. Wiring

Deteriorated electrical insulation: Nicks, abrasions, or fraying of the insulation that exposes any conducting wire

No deterioration

Housing Unit 134. Ground Fault Circuit Interrupters (GFCI)

Inoperable or missing

Operable

Housing Unit 135. Arc Fault Circuit Interrupters (AFCI)

Inoperable or missing

Operable

Housing Unit 136. Missing or Broken Electrical Covers

Exposed wiring: An open breaker port or exposed wiring

-OR-A cover is missing and electrical connections are exposed

None missing/broken/exposed

Housing Unit 137. Child Tamper-resistant Outlet Covers

No tamper-resistant outlet covers in units with young children

Installed tamper-resistant outlet covers in units with young children

Not applicable (no young children in unit)

Housing Unit 138. Extension Cord Use

Extension cords not used properly: Extension cords under carpets or across doorways

-OR-Too many appliances plugged into one extension cord

Extension cords used properly: Extension cords not draped across doorways or under carpets and not overloaded with too many appliances

No extension cord use

Housing Unit 139. Extension Cord Condition

Not good: Extension cords cracked or frayed

Good: Extension cords not cracked or frayed

No extension cord use

WATER HEATER

Housing Unit 140. Water Heater Exhaust

Misaligned: Any misalignment that may cause improper or dangerous venting of gases.

Not misaligned

Does not apply: Electrical hot water or heater used instead of gas-fired or oil-fired unit

-OR-No water heater inside unit.

NOTE: If no water heater inside unit, skip to question 145.

Housing Unit 141. Water Temperature

Temperature set at or above 120°F

No hot water

Temperature set below 120°F

Housing Unit 142. Leaks

Water leak observed

 No water leak observed

Housing Unit 143. Water Heater Temperature/Pressure Relief Valve

Absent

Present

NOTE: Do not operate the relief valve.

Housing Unit 144. Water Heater Secured

Not strapped down

Strapped down

HVAC System

Housing Unit 145. General Rust/Corrosion (HVAC)

Significant rust/corrosion: Significant deterioration from rust and corrosion on HVAC units in the dwelling unit (includes ducts, radiators, baseboard heaters, etc.). The system does not provide sufficient heating or cooling.

Surface rust/corrosion: Deterioration from rust and corrosion on HVAC units in the dwelling unit (includes ducts, radiators, baseboard heaters, etc.). The system still provides sufficient heating or cooling.

No rust/corrosion in HVAC units in the dwelling unit (includes ducts, radiators, baseboard heaters, etc.)

Housing Unit 146. HVAC Operation

Not working: HVAC system does not function; it does not provide the heating or cooling it should. The system does not respond when the controls are engaged.

Working

Housing Unit 147. Supply Air for HVAC (From Basement Only)

Supply (return) air entirely from living area

No forced air system present

Supply (return) air includes fresh (outdoor) air

Housing Unit 148. HVAC Filters

Need replacement

Clean

Not applicable

Housing Unit 149. HVAC Exhaust Ventilation System

Reversed air flow in chimney observed: REPORT TO BUILDING MANAGEMENT/OWNER IMMEDIATELY AND RECORD SPECIFICS IN THE COMMENTS SECTION

Misaligned, damaged, blocked, rusted, corroded, or disconnected

Not misaligned, damaged, blocked, or disconnected

No exhaust ventilation required (e.g., electric or no HVAC systems in unit)

Housing Unit 150. HVAC Noise

Noisy/vibrating/leaking: HVAC system shows signs of abnormal vibrations, other noise, or leaks when engaged

Not noisy

Does not apply: No HVAC inside unit

Housing Unit 151. Space Heaters

Space heaters used in unit are not at least 3 feet from anything that can burn

Space heaters used in unit are at least 3 feet from anything that can burn

Not applicable: No space heaters used in unit

Housing Unit 152. Fireplace Screen

Fireplace does not have a sturdy screen to catch sparks

Fireplace has a sturdy screen to catch sparks

Not applicable: No fireplace in unit

Housing Unit 153. Fireplace Dampers

Fireplace dampers not operational

Fireplace dampers operational

Not applicable: No fireplace in unit

Housing Unit 154. Wood Stove Barrier

No barrier to keep children from getting too close to wood stove surfaces

Barrier in place to keep children away from wood stove surfaces

Not applicable: No wood stove in unit

Kitchen

Housing Unit 155. Cabinets

≥50% cabinets or cabinet doors missing: More than 50% of the cabinets or doors are missing

<50% cabinets or cabinet doors missing: Less than 50% of the cabinets, doors, or shelves are missing

No doors missing

Housing Unit 156. Cabinet Damage

≥20% damaged or laminate separation

<20% damaged or laminate separation

No damage or laminate separation

Housing Unit 157. Countertops

≥20% missing/damaged: More than 20% of the countertop working surface is missing, deteriorated, or damaged below the laminate. Countertop is not a sanitary surface on which to prepare food.

<20% missing/damaged: 20% or less of the countertop working surface is missing, deteriorated, or damaged below the laminate. Countertop is not a sanitary surface on which to prepare food.

No missing/damaged countertops

Housing Unit 158. Dishwasher

Not working: The dishwasher does not function as it should

Working

No dishwasher

Housing Unit 159. Garbage Disposal

Not working: The garbage disposal does not function as it should

Working

No garbage disposal

Housing Unit 160. Kitchen Drain

Kitchen drain completely clogged: Drain completely clogged or extensively deteriorated

Slow kitchen drain: Basin does not drain freely

Kitchen drain working properly

Housing Unit 161. Kitchen Plumbing

Steady leak/adverse effect: A steady leak is having an adverse effect on the surrounding area -OR-The kitchen faucet or pipe is not usable

Leak contained by kitchen sink: A leak or drip is contained by the basin or pipes and the faucet is functioning properly

No leak

Housing Unit 162. Electrical

No GFCI near kitchen sink

-OR-GFCI does not work properly

GFCI is near kitchen sink and it works properly

Housing Unit 163. Water Temperature

Only hot water present at kitchen plumbing fixtures

Only cold water present at kitchen plumbing fixtures

Hot and cold water present at kitchen plumbing fixtures

Housing Unit 164. Water Pressure

Inadequate water pressure at kitchen plumbing fixtures

Adequate water pressure at all kitchen plumbing fixtures

Housing Unit 165. Range Hood

Not working: Range hood does not turn on

Partial blockage: An accumulation of dirt threatens the free passage of air

-OR-Flue completely blocked

No range hood/exhaust fan

No blockage/functional: Range hood works properly

Housing Unit 166. Range or Stove

Stove and/or oven missing

Two or more burners not working

Gas ranges: flames not distributed equally or pilot lights out on two or more burners Electric ranges: two or more heating elements (including the oven) not working

One burner not working:

Gas ranges: flames not distributed equally or pilot lights out on one burner Electric ranges: one heating element (including the oven) not working

Stove and oven working

Housing Unit 167. Refrigerator

Refrigerator missing or inoperable

Seals deteriorated: Refrigerator has an excessive accumulation of ice

-OR-Seals around refrigerator doors are deteriorated

-OR-Refrigerator does not cool adequately for the safe food storage (temperature above 40°F)

Refrigerator functioning properly (temperature 40°F or below)

Housing Unit 168. Kitchen Sink

≥50% discoloration, chips, or cracks or inoperable: Sink cannot be used because of extensive discoloration, chips, or cracks

-OR-Sink cannot be used because the sink or associated hardware is missing or has failed

<50% discoloration, chips, or cracks: Sink can be used but cracks, chips, or extensive discoloration are seen in less than 50% of the basin

-OR-A stopper is missing

No cracks/discoloration/chips; sink operable

Housing Unit 169. Permanent Carpet on Kitchen Floor

Permanent carpet on kitchen floor (does not include removable mats)

Kitchen floor is a hard, cleanable surface

Housing Unit 170. Cleaning Products

Cleaning products not stored out of the reach of children

Cleaning products stored out of the reach of children

No cleaning products stored in kitchen area

LAUNDRY AREA

Housing Unit 171. Clothes Dryer

Vent missing: Dryer vent to outside is missing

Vent damaged: Dryer exhaust is not effectively vented to the outside because of blockage or inadequate design or is vented into the interior

Vent not missing or damaged: Exhaust vent is functioning properly

No dryer

Housing Unit 172. Exhaust Duct From Dryer

Flexible plastic: Dryer exhaust duct is made of flexible plastic

Flexible metal: Dryer exhaust duct is made of flexible metal

Other: Wood or other combustible material

Rigid metal: Dryer exhaust duct is made of rigid metal

Housing Unit 173. Dryer Venting

Dryer vents to basement

Dryer vents to attic

Dryer vents to crawl space

Other: _______No Dryer________________

Dryer vents to outside

LIGHTING

Housing Unit 174. Interior Housing Unit Lighting

One or more lights missing: In one or more rooms in a unit, a permanent lighting fixture is missing, and no other switched light source is functioning in the room

One or more lights not working: In one or more rooms in a unit, a permanent lighting fixture is not working, and no other switched light source is functioning in the room

All lights working/none missing

Housing Unit 175. Outlets/Switches

Broken, wires exposed: Broken cover plates with wires exposed

-OR-Outlets or switches missing

Broken, but no exposed wires

No broken cover plates

PATIO/PORCH/DECK/BALCONY

Housing Unit 176. Railings

Missing: The baluster or side rails are missing

Loose or damaged: The baluster or side rails enclosing this area are loose or damaged

No damage

Housing Unit 177. Electrical Outlets

No GFCIs present

-OR-GFCIs not functional

GFCIs present and functional

No exterior outlets

Housing Unit 178. Spindles and Railings

Missing: Spindles or railings missing on porch, deck, or balcony

Present: Spindles and railings present on porch, deck, or balcony

Not applicable: No porch, deck, or balcony

Housing Unit 179. Spindles and Railings: Condition

Damaged

Loose

Too low

Too far apart

Missing

Good condition and properly spaced

Not applicable: No porch, deck, or balcony

Housing Unit 180. Spindles

Spindles more than 4 inches apart

Spindles not more than 4 inches apart

Not applicable: No porch, deck, or balcony

Housing Unit 181. Railing Height

Railing is not between 30 and 42 inches in height

Railing is between 30 and 42 inches in height

Not applicable: No porch, deck, or balcony

Housing Unit 182. Patio Surface

≥¾ inch displacement

≤¾ inch displacement

Uneven steps

No cracks/level

SMOKE AND CARBON MONOXIDE DETECTORS

Housing Unit 183. Smoke Detectors

Not operational: At least one smoke detector tested in each unit; detector does not work as designed

No smoke detector present: No smoke detector in unit

Operational: One smoke detector tested in each unit (if feasible); detector works as designed

Housing Unit 184. Smoke Detector Location

No smoke detectors in unit

Smoke detectors in home, but not on every level, outside each bedroom, and in a common living area

Smoke detectors on every level of the home, outside each bedroom, and in a common living area

Housing Unit 185. Smoke Detector Power

No smoke detectors in unit

Smoke detector powered by main electrical supply without battery backup

Smoke detector powered by battery

Smoke detector powered by main electrical supply with battery backup

Housing Unit 186. CO Detectors

Not operational: At least one CO detector tested in each unit; detector does not work as designed

No CO detector present: No CO detector in unit

Operational: All CO detectors tested in each unit (if feasible); all detector(s) work as designed

Housing Unit 187. CO Detector Location

No CO detectors in unit

CO detector in dwelling unit but not near bedroom area

CO detector near bedroom area

Housing Unit 188. Fire Extinguisher

No fire extinguisher present

Fire extinguisher present in home

Fire extinguisher present in home and charged

STAIRS

Housing Unit 189. Stair Railings

Missing: Handrail missing

Broken, insecure, or missing: Handrail damaged, loose, or otherwise unusable or insecure

Handrail present on both sides and not broken, missing, or insecure

Does not apply: No stairs or three or fewer stairs

Housing Unit 190. Steps: Condition

One or more broken or missing: One or more steps are broken or missing

Not broken or missing: No broken or missing steps

Does not apply: No steps

Housing Unit 191. Steps: Covering

No covering on stairs

Covering on stairs is not firmly attached or is poor condition

Covering on stairs (e.g., nonslip tread covers) is firmly attached and in good condition

Windows

Housing Unit 192. Windows

One or more windows missing

One or more windows cracked or broken

One or more windows cannot be opened

All windows intact and can be opened

Housing Unit 193. Window Sills

Missing or damaged: A sill is missing or damaged, but the inside of the surrounding wall is not exposed and is still weathertight

Not weathertight: A sill is missing or damaged enough to expose the inside of the surrounding wall and compromise its weather tightness



Housing Unit 194. Window Locks

Not functioning and cannot be secured/locked

Not functioning but can be secured/locked

Functioning and lockable

Housing Unit 195. Window Caulking/Seals

Missing/deteriorated (leaks present): There is missing or deteriorated caulk or seals and evidence of leaks or damage to the window or surrounding structure

Missing/deteriorated (no leaks): There is missing or deteriorated caulk on widows, but there is no evi​dence of damage to the window or surrounding structure

Not missing/deteriorated

Housing Unit 196. Window Paint

Deteriorating paint: Deteriorating paint or a window that needs paint on 10% or more of its surface

No deteriorating paint: All paint intact or deteriorating paint on less than 10% of the surface

COMMENTS, HOUSING UNIT SECTION

Other Items (Items 197–229)

Issues to assess in this area include

· Garbage and debris

· Injury hazards

· Childproofing measures

· Poisoning hazards

· Pest hazards

· Moisture hazards

· Swimming pool, spa, or whirlpool

· Other hazards

A comment area for the other items category is also included in this section.

GARBAGE AND DEBRIS

Other 197. Indoors

Garbage and debris not properly stored: Missing, uncovered, or leaking container

Garbage and debris properly stored

NOTE: This does not include garbage or debris improperly stored outside, which are addressed in Other 198.

Other 198. Outdoors

Garbage and debris not properly stored: Missing, uncovered, or leaking container

Garbage and debris properly stored

NOTE: This does not include garbage or debris improperly stored inside, which are addressed in Other 197.

INJURY HAZARDS

Other 199. Sharp Edges

Yes: Physical hazard present that could produce a skin cut or injury

No: Sharp edges not present

199b. If yes, record location(s): ______________________________

Other 200. Trip Hazards

Yes: Tripping hazards present No: Tripping hazards not present

200b. If yes, record location(s): ______________________________

Other 201. Garage Door Opener

Garage door does not reverse properly

Garage door opener reverses properly

No garage door or no garage

CHILDPROOFING MEASURES

NOTE: These questions pertain to households where young children live or visit. If young children do not live in or visit the house/unit, skip to Other 208.

Other 202. Window Cords (Strangulation Hazard)

Yes: Window cords looped or tied together

No: Window cords not looped or tied together

202b. If yes, record location: ______________________________

Other 203. Window Guards

Missing or not operational

Present and operational

Other 204. Cabinet Locks

Childproof cabinet locks missing or not operational

Childproof cabinet locks in place and operational

Other 205. Water Safety

Toilets not covered (toilet lids open)

Toilets covered (toilet lids closed)

Other 206. Chemicals, Pesticides, Cleaning Supplies, or Medications Stored Within Easy Reach of Children

Yes

No

206b. If yes, record type and location: ______________________________

Other 207. Hobbies

Evidence of household hobbies that could pose a risk to young children

No evidence of household hobbies that could pose a risk to young children

POISONING HAZARDS

Other 208. Unvented Combustion Appliances

Yes: Unvented combustion appliances (e.g., fuel-fired space heaters, gas clothes dryers, gas logs, charcoal, stoves etc.) present

No: Unvented combustion appliances (e.g., fuel-fired space heaters, gas clothes dryers, gas logs, charcoal, stoves etc.) not present

208b. If yes, record type and number: ______________________________

Other 209. Attached Garage

Attached garage not sealed from living area

Do not know: Not sure whether attached garage sealed from living area

Attached garage sealed from living area

Not applicable: No attached garage

PEST HAZARDS

Other 210. Infestation: Roaches

Frass or shells

One or more live roaches

No roaches or roach evidence

210b. If roach evidence present, record location(s): ___________________

NOTE: This does not include infestations of other other pests, which are addressed in Other 211 and 212.

Other 211. Infestation: Rats or Mice

Droppings or chewed holes

One or more rats/mice

No rats/mice/droppings/holes

211b. If rat or mouse evidence present, record location(s): ___________________

NOTE: This does not include infestations of other pests, which are addressed in Other 210 (roaches) and Other 212 (other insects or vermin).

Other 212. Other Insects or Vermin

Yes: Other insects or vermin seen

No: Other insects or vermin not seen

212b. If yes, record and location(s) type: ______________________________

Other 213. Termite Tunnels

Yes: Termite tunnels

No: No termite tunnels

213b. If seen, where in unit: _____________________________

MOISTURE HAZARDS

Other 214. Sources of Excessive Humidity Present

Yes: Sources of humidity (e.g., humidifier, dryer vented inside, uncovered fish tank) present

No: Sources of humidity (e.g., humidifier, dryer vented inside, uncovered fish tank) not present

214b. If yes, record type and number: ______________________________

Other 215. Moldy or Musty Odor Present

Yes

No

215b. If yes, record location: ______________________________

Other 216. Dehumidifier Present

No

Yes

SWIMMING POOL, SPA, OR WHIRLPOOL

NOTE: These questions pertain to homes/units with a swimming pool, spa, or whirlpool. If there are no swimming pools, spas, or whirlpools, skip to Other 224.

Other 217. Fencing and Gates

Missing or broken fencing or gate

Damaged fencing or gate open

Pool surrounded by undamaged three-sided fencing (house acts as fourth side)

Pool surrounded by undamaged four-sided fencing

Other 218. Doors and Gates

All doors and gates to swimming pool and spa areas do not close and latch automatically

All doors and gates to swimming pool and spa areas close and latch automatically

Other 219. Latches

Latching devices are not at least 48 inches from the ground

Latching devices are not self-closing, self-latching

Self-closing, self-latching devices are at least 48 inches from the ground

Other 220. Safety Equipment (Swimming Pool)

None

Life ring

Shepherd’s hook

Both life ring and shepherd’s hook

Other 221. GFCI

No GFCI in area

GFCI present but not working

GFCI present and working in area

Other 222. Drain Cover

Drain cover missing or broken: SHUTDOWN POOL, SPA, OR WHIRLPOOL IMMEDIATELY AND REPORT TO BUILDING MANAGEMENT/OWNER. RECORD SPECIFICS IN THE COMMENTS SECTION.

Drain cover in place and not broken

Other 223. Safety Cover

No safety cover on spa

Unlocked safety cover on spa

Locked safety cover on spa

OTHER HAZARDS

Other 224. Visible Dust on Surfaces

Heavy

Slight

No visible dust on surfaces

Other 225. Air Cleaning Device Present

Yes

No

Other 226. Ozone Generator Present

Yes

No

Other 227. Pets Present

Yes

No

227b. If yes, record type and number of pet(s): ______________________________

Other 228. Tobacco Smoke or Odor Present

Yes

No

Other 229. Other Hazards

Yes

No

229b. If yes, record type and location: ______________________________

COMMENTS, OTHER ITEMS SECTION

OVERALL COMMENTS ON THIS INSPECTION Add any other comments related to this inspection here.