Fillable Printable Home Investment Partnerships Program

Home Investment Partnerships Program

HOME – Long Term MonitoringPROPERTY STANDARDS CHECKLIST

Monitor Name:City/County of:

Contract #: Inspection Date:

Project Name: # Total units: # HOME units:

Unit Address:

City: Zip:

Tenant Name: Unit #:

# Bedrooms: 0 1 2 3 4 5

# Bathrooms: 0 1 2 3

Housing Type:

___ One level apt / duplex ___ SRO

___ Two level apt / duplex / townhouse ___ Studio

___ Single family detached house ___ Cooperative

___ Manufactured Home ___ Shared Housing

___ Mobile Home ___ Other: _______________________

UtilitiesComments

Gas: on / offElectricity: on / off

Unit heated by:__ gas wall __ central __hydronic __ other:________________

Air Conditioner__ wall __ central __ none provided

Smoke Detector(s) –

operating on each

level of the unit?

__ battery __ hardwire TOK ___Y ___N

Water Heater__ gas __ electric __instant heat __other:____________________

__ section below n/a if project has instant heat system

Is water heater strapped? __Y __N

Is the water heater closet also designed for storage? __Y __N

If yes, is there a 3 foot clearance around the water heater? __Y __N

If no, does the tenant need to remove items from the closet? __Y __N

Lead Based Paint

If prior to 1978, are all

painted surfaces free

of deteriorated paint?

__ not applicable or __construction/rehab prior 1978

Yes ____ No ____ If No, LBPstabilization may be required. See

Lead Based Paint Instructions in HUD Inspection Checklist 52580

HOME Contract ManagementManual

Rev. January 20091

UNIT INSPECTION CHECKLIST

LivingRoom__ Sleeping Area

(SRO/Studio)

Item#

Pass

Fail

Incon-

clusive

Comments:

1.1Is LR present?YesNo

1.2Electricity

1.3Electrical Hazards□ N/A

1.6CeilingCondition

1.7WallCondition

1.8Floor Condition

__tile __lino __carpet __other

1.5Window Condition

1.4Security

Kitchen __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments:

2.1Is Kitchen present?YesNo

2.2Electricity

2.3Electrical Hazards□ NotApplicable

2.6Ceiling Condition

2.7Wall Condition

2.8Floor Condition__tile __lino __other

2.10Range□ Gas □Electric

2.10Range Hood Light□ None

2.10Range Hood Fan□ None

2.10Microwave fan/light□ None

2.11Refrigerator

2.12Sink□ repairleak

2.13Space

for Storage, Preparation, and Serving of food

2.9Garbage Disposal□ None

2.5Window Condition□ None

2.4Security□ None

NOTE: Must have openablewindow ifno RangeHoodFan

HOME Contract ManagementManual

Rev. January 20092

Summary Decision On Unit(To be completed after form has been filled out)

□Pass Inspection – Date: ___________________________________________

□Inconclusive (i.e. electricity off) – Date: ________________________________

□FailInspection – Date: _____________________________________________

□Pass Re-inspection – Date: ____________________________________

Additional Comments:

□ replace receptacle/missing cover plate

□ repair water damage

□ patch/cover hole

□ repair tripping hazard

□ repair/replace pane, frame, sill

□ repair/replace broken lock, crank, handle

UNIT INSPECTION CHECKLIST

Dining Room or DiningArea: __ N/A

Item#

Yes /

Pass

No /

Fail

Incon-

clusive

4.1

Location

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

Bathroom # 1 located:Hall Master other __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments:

____ ½ bath ____ Fullbath

3.1Bathroom present?YesNo

3.2Electricity

3.3Electrical Hazards□ NotApplicable

3.4DoorSecurity

3.6CeilingCondition

Mold? __Y__N

3.7WallCondition

Mold? __Y__N

3.8Floor Condition

__tile__lino __carpet __other

3.10Toilet / Caulking

Toilet rocks? __Y __N

3.11Sink / Plumbing□ repair leak

3.12Tub or Shower□ None

3.13Exhaust Fan□ None

3.5Window Condition□ None

NOTE: Must have openablewindow ifno Exhaust Fan

HOME Contract ManagementManual

Rev. January 20093

Additional Comments:

□ replace receptacle/missing cover plate

□ repair water damage

□ patch/cover hole

□ repair tripping hazard

□ repair/replace pane, frame, sill

□ repair/replace broken lock, crank, handle

UNIT INSPECTION CHECKLIST

Bedroom # 1 __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments: __ front __ center __ rear

Floor Level: _________

4.1

Location

__ Right __ Center__ Left

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

Bedroom # 2 __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments: __ front __ center __ rear

Floor Level: _________

4.1

Location

__ Right __ Center__ Left

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

HOME Contract ManagementManual

Rev. January 20094

Bathroom # 2 located:Hall Master other __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments:

____ ½ bath ____ Fullbath

3.1Bathroom present?YesNo

3.2Electricity

3.3Electrical Hazards□ NotApplicable

3.4DoorSecurity

3.6CeilingCondition

Mold? __Y__N

3.7WallCondition

Mold? __Y__N

3.8Floor Condition

__tile__lino __carpet __other

3.10Toilet / Caulking

Toilet rocks? __Y __N

3.11Sink / Plumbing□ repair leak

3.12Tub or Shower□ None

3.13Exhaust Fan□ None

3.5Window Condition□ None

NOTE: Must have openablewindow ifno Exhaust Fan

Bathroom # 3 located: Hall Master other __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments:

____ ½ bath ____ Fullbath

3.1Bathroom present?YesNo

3.2Electricity

3.3Electrical Hazards□ NotApplicable

3.4DoorSecurity

3.6CeilingCondition

Mold? __Y__N

3.7WallCondition

Mold? __Y__N

3.8Floor Condition

__tile__lino __carpet __other

3.10Toilet / Caulking

Toilet rocks? __Y __N

3.11Sink / Plumbing□ repair leak

3.12Tub or Shower□ None

3.13Exhaust Fan□ None

3.5Window Condition□ None

NOTE: Must have openablewindow ifno Exhaust Fan

Bedroom # 3 __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments: __ front __ center __ rear

Floor Level: _________

4.1

Location

__ Right __ Center__ Left

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

HOME Contract ManagementManual

Rev. January 20095

Bedroom # 4 __ N/A

Item#

Pass

Fail

Incon-

clusive

Comments: __ front __ center __ rear

Floor Level: _________

4.1

Location

__ Right __ Center__ Left

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

Other Rooms used for Living and Halls

Circle Room Code: 1 2 3 4 5

Item#

Pass

Fail

Incon-

clusive

Comments: __ front __ center __ rear

Floor Level: _________

4.1

Location

__ Right __ Center__ Left

4.2Electricity

4.3Electrical Hazards□ NotApplicable

4.4Security

4.6Ceiling Condition

Mold? __Y__N

4.7Wall Condition

Mold? __Y__N

4.8Floor Condition

__tile__lino __carpet __other

4.9Closet Door(s)□ None

4.5Window Condition□ None

* Room Codes:

1= Bedroom

2 = DiningRoom or Dining Area;

3 = Second Living Room, FamilyRoom, Den, Playroom, TVRoom;

4 = Entrance Halls,Corridors, Halls,Staircases;

5 = Other

HOME Contract ManagementManual

Rev. January 20096

Additional Comments:

HOME Contract ManagementManual

Rev. January 20097