Fillable Printable Home Investment Partnerships Program
Fillable Printable Home Investment Partnerships Program
Home Investment Partnerships Program
HOME – Long Term Monitoring PROPERTY 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: _______________________
Utilities Comments
Gas: on / off Electricity: 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, LBP stabilization may be required. See
Lead Based Paint Instructions in HUD Inspection Checklist 52580
HOME Contract Management Manual
Rev. January 2009 1
UNIT INSPECTION CHECKLIST
Living Room __ Sleeping Area
(SRO/Studio)
Item #
1
Pass
Fail
Incon-
clusive
Comments:
1.1 Is LR present? Yes No
1.2 Electricity
1.3 Electrical Hazards □ N/A
1.6 Ceiling Condition
1.7 Wall Condition
1.8 Floor Condition
__tile __lino __carpet __other
1.5 Window Condition
1.4 Security
Kitchen __ N/A
Item #
2
Pass
Fail
Incon-
clusive
Comments:
2.1 Is Kitchen present? Yes No
2.2 Electricity
2.3 Electrical Hazards □ Not Applicable
2.6 Ceiling Condition
2.7 Wall Condition
2.8 Floor Condition __tile __lino __other
2.10 Range □ Gas □ Electric
2.10 Range Hood Light □ None
2.10 Range Hood Fan □ None
2.10 Microwave fan/light □ None
2.11 Refrigerator
2.12 Sink □ repair leak
2.13 Space
for Storage, Preparation, and Serving of food
2.9 Garbage Disposal □ None
2.5 Window Condition □ None
2.4 Security □ None
NOTE: Must have openable window if no Range Hood Fan
HOME Contract Management Manual
Rev. January 2009 2
Summary Decision On Unit (To be completed after form has been filled out)
□ Pass Inspection – Date: ___________________________________________
□ Inconclusive (i.e. electricity off) – Date: ________________________________
□ Fail Inspection – Date: _____________________________________________
□ Pass Re-inspection – 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 Dining Area: __ N/A
Item #
4
Yes /
Pass
No /
Fail
Incon-
clusive
4.1
Location
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
Bathroom # 1 located: Hall Master other __ N/A
Item #
3
Pass
Fail
Incon-
clusive
Comments:
____ ½ bath ____ Full bath
3.1 Bathroom present? Yes No
3.2 Electricity
3.3 Electrical Hazards □ Not Applicable
3.4 Door Security
3.6 Ceiling Condition
Mold? __Y __N
3.7 Wall Condition
Mold? __Y __N
3.8 Floor Condition
__tile __lino __carpet __other
3.10 Toilet / Caulking
Toilet rocks? __Y __N
3.11 Sink / Plumbing □ repair leak
3.12 Tub or Shower □ None
3.13 Exhaust Fan □ None
3.5 Window Condition □ None
NOTE: Must have openable window if no Exhaust Fan
HOME Contract Management Manual
Rev. January 2009 3
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 #
4
Pass
Fail
Incon-
clusive
Comments: __ front __ center __ rear
Floor Level: _________
4.1
Location
__ Right __ Center __ Left
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
Bedroom # 2 __ N/A
Item #
4
Pass
Fail
Incon-
clusive
Comments: __ front __ center __ rear
Floor Level: _________
4.1
Location
__ Right __ Center __ Left
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
HOME Contract Management Manual
Rev. January 2009 4
Bathroom # 2 located: Hall Master other __ N/A
Item #
3
Pass
Fail
Incon-
clusive
Comments:
____ ½ bath ____ Full bath
3.1 Bathroom present? Yes No
3.2 Electricity
3.3 Electrical Hazards □ Not Applicable
3.4 Door Security
3.6 Ceiling Condition
Mold? __Y __N
3.7 Wall Condition
Mold? __Y __N
3.8 Floor Condition
__tile __lino __carpet __other
3.10 Toilet / Caulking
Toilet rocks? __Y __N
3.11 Sink / Plumbing □ repair leak
3.12 Tub or Shower □ None
3.13 Exhaust Fan □ None
3.5 Window Condition □ None
NOTE: Must have openable window if no Exhaust Fan
Bathroom # 3 located: Hall Master other __ N/A
Item #
3
Pass
Fail
Incon-
clusive
Comments:
____ ½ bath ____ Full bath
3.1 Bathroom present? Yes No
3.2 Electricity
3.3 Electrical Hazards □ Not Applicable
3.4 Door Security
3.6 Ceiling Condition
Mold? __Y __N
3.7 Wall Condition
Mold? __Y __N
3.8 Floor Condition
__tile __lino __carpet __other
3.10 Toilet / Caulking
Toilet rocks? __Y __N
3.11 Sink / Plumbing □ repair leak
3.12 Tub or Shower □ None
3.13 Exhaust Fan □ None
3.5 Window Condition □ None
NOTE: Must have openable window if no Exhaust Fan
Bedroom # 3 __ N/A
Item #
4
Pass
Fail
Incon-
clusive
Comments: __ front __ center __ rear
Floor Level: _________
4.1
Location
__ Right __ Center __ Left
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
HOME Contract Management Manual
Rev. January 2009 5
Bedroom # 4 __ N/A
Item #
4
Pass
Fail
Incon-
clusive
Comments: __ front __ center __ rear
Floor Level: _________
4.1
Location
__ Right __ Center __ Left
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
Other Rooms used for Living and Halls
Circle Room Code: 1 2 3 4 5
Item #
4
Pass
Fail
Incon-
clusive
Comments: __ front __ center __ rear
Floor Level: _________
4.1
Location
__ Right __ Center __ Left
4.2 Electricity
4.3 Electrical Hazards □ Not Applicable
4.4 Security
4.6 Ceiling Condition
Mold? __Y __N
4.7 Wall Condition
Mold? __Y __N
4.8 Floor Condition
__tile __lino __carpet __other
4.9 Closet Door(s) □ None
4.5 Window Condition □ None
* Room Codes:
1= Bedroom
2 = Dining Room or Dining Area;
3 = Second Living Room, Family Room, Den, Playroom, TV Room;
4 = Entrance Halls, Corridors, Halls, Staircases;
5 = Other
HOME Contract Management Manual
Rev. January 2009 6
Additional Comments:
HOME Contract Management Manual
Rev. January 2009 7
