Fillable Printable Home Inspection Report Software

Home Inspection Report Software

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

The checklist is used prior to anyone moving into a home or apartment. It is important all Independent

Support Coordination agencies and residential providers are aware of these items so appropriate

residences are selected for people. Some basic items that should be in place before a home or apartment

is selected or occupied are:

1. **At least one smoke detector must be operable.

2. **Lights must have globe covers including those in closets.

3. **There is a second means of exit (window or door).

4. **All outlets near a water source (i.e.: sink) must be GFCI.

5. **Handrails must be present on exterior steps and ramps.

6. **Windows made to open easily and stay open without props.

7. **A second floor bedroom can not be used for a person using an ambulation aid.

Inspection Codes:

Pass: Meets specified requirement acceptable for move in or continued occupancy.

**Fail: Does not meet specified requirement acceptable for move in or continued occupancy. The deficiency

found would impact the health of the participant and/or safety of the unit and needs correction within 30 days.

YES

**Are there any leaks in the roof or ceiling?

Are there any holes in the floor or walls?

Are there any plumbing leaks or other plumbing problems?

Are there any electrical problems?

**Are there any cracks or breaks in any of your windows?

Are there any locks on all of your windows in each room?

**Will at least one window in each room remain up when raised?

Do your oven and all 4 burners on your stove work properly?

Does your freezer or refrigerator work properly?

Do you have any bugs or mice?

Do you have a key to unlock your doors?

What kind of water do you have?

CITY

WELL

Do you have any problems with your water, such as leaks, rust or

corrosion, odors or inadequate pressure?

What kind of air conditioning do you have?

Central

None

Is your heat……?

GAS

ELECTRIC

If gas, is it…….

NATURAL

PROPANE

What kind of heat do you have?

Central

Ventless Gas

Wood

Baseboard

Radiant

Other

Are you having any problems with your heat?

YES

WHAT KIND

Do persons use a wheelchair or an ambulation aid?

YES

If so, do any consumers self-propel?

YES

If so, are all interior floors hard for easy ambulation/propelling?

YES

If no, what rooms make it difficult to self-propel?

Revised 4/22/15

DIDD-0498 1

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

101.00

Is there a living room?

102.01

Are there at least two working outlets or one

working outlet and one working permanently

installed ceiling or wall light fixture?

103.01

Are all outlets/switches flush with the wall and do

they have unbroken tight fitting cover plates?

103.02

Are light fixtures/ceiling fans secured to wall or

ceiling?

**103.03

Is room free from any frayed or exposed wiring and

is the wiring the proper type?

**103.05

Do all permanently installed ceiling or walk light

fixtures have covers, if they were designed to have

covers?

**104.01

Do all windows and doors that are accessible from

the outside have secure frames and acceptable

locks that work? NOTE: Padlocks are not allowed:

if door is partially glass then doubled keyed locks

are allowed (if there is not glass present, then the

“flip” type lock can be installed.)

105.01

Is there at least one window? (which opens to the

exterior)

**105.02

Are all windows airtight, free of breaks/cracks and

do sashes meet? Any other deterioration?

105.03

If windows are made to open, will at least one

window open? (SEE ITEM 830.02) Does this

window have a screen, if no central A/C? Is screen

torn, missing, need to be replaced? NOTE: Props

are not allowed in any windows.

105.06

Are exterior doors airtight, have adequate weather

stripping and sound threshold? If storm door is

present, is it properly installed?

105.07

Are interior doors opening into rooms properly

installed and stay shut? Any hazardous

conditions? Doorknobs properly installed?

105.08

Are closet doors properly installed and do they

shut? Any hazardous conditions? Doorknobs

properly installed?

106.01

Is the ceiling sound and free from hazardous

defects, leaks, holes, bulges?

107.01

Are the walls sound and free from hazardous

defects, or holes?

**108.01

Is the floor sound and free from hazardous defects,

holes, bulges, soft spot or tripping hazards?

109.01

Are all large interior painted surfaces (ceilings,

floors, doors, walls, etc.) free of deteriorated paint?

118.02

Is there a direct or indirect heat source?

119.04

Does the permanent heater have a knob, and

appear to be properly installed? (Wall units,

baseboards, vented gas, etc.)

Revised 4/22/15

DIDD-0498 2

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

KITCHEN

**202.01

Is there at least one working outlet or one working

permanently installed ceiling or wall light fixture?

(All outlets near water source must have GFCI.)

203.01

Are all outlet fixtures flush with the wall and do they

have unbroken, tight fitting cover plates?

203.02

Are light fixtures/ceiling fans secured to the wall or

ceiling?

203.03

Are stove and refrigerator plugged into an outlet?

NOTE: The stove or refrigerator cannot be

plugged in an extension cord.

205.07

Are interior doors opening into rooms properly

installed and stay shut? Any hazardous

conditions? Door knobs properly installed?

205.08

Are closet doors properly installed and stay shut?

Door knobs properly installed?

209.01

Does the vent fan over the stove operate properly?

**210.01

Is there a microwave or stove with an oven and all

burners working?

210.02

Is the oven door secure and knobs and handles

present? Is there at least one rack in the oven?

**211.01

Is there a refrigerator that freezes and cools

properly? Check gaskets/seals. Are there any

other safety hazards? Is there at least one shelf

present? Is grill present? If designed to have a

grill?

**212.01

Is there a sink in the kitchen with hot and cold

water? Are handles present? Does the water

drain properly? Is there adequate water pressure?

212.02

Is the trap properly installed?

212.03

Are all pipes and the faucet free from leaks or

drips?

212.04

Are holes around the pipes covered?

213.01

Is there a space to store and prepare food?

213.02

Are cabinet doors and drawers properly installed?

Knobs or handles present?

218.02

Is there a direct or indirect heat source?

219.04

Does the permanent heater have a knob, and

appear to be properly installed? (Wall units,

baseboards, vented gas, etc.)

**219.05

Is there a fire extinguisher in the kitchen?

BATHROOM

**302.01

Bathroom has GFCI near water source/sink?

305.05

Is there no operable window? Is there a vent fan

present?

305.07

Does vent fan operate properly in bathroom?

**312.01

Is there a sink in the bathroom with hot and cold

water? Are handles present? Does the water

drain properly? Is there adequate water pressure?

314.01

Is there a flush toilet in an enclosed room?

314.02

Does the toilet flush and shut off properly? Is it

free from leaks/cracks, and does it have a toilet

seat and tank top?

Revised 4/22/15

DIDD-0498 3

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

**315.01

Is there a tub or shower with hot and cold running

water? Is there adequate water pressure?

312.01

Is the tub or shower free from leaks or drips and

sharp objects, and does it drain properly? Are

handles and levers present? Is there a need for

caulking in or around the tub/shower area?

316.01

Is there a door for privacy?

318.02

Is there a direct or indirect heat source?

319.04

Does the permanent heater have a knob, and

appear to be properly installed? (Wall units,

baseboards, vented gas, etc.)

BEDROOM(S)

**405.01

Is there at least one window, which opens to the

exterior?

418.03

Is the room free of a ventless gas heater?

**432.02

Is there a smoke detector located outside the

bedroom?

**432.03

Does the smoke detector operate properly?

502.01

Is there a means of illumination e.g. light fixture,

wall outlet, windows in halls and living areas?

532.02

If this room is used for sleeping, is there a smoke

detector located outside the bedroom?

**532.03

Does the smoke detector operate properly and one

in the hallway?

**632.01

If basement, is there a smoke detector present?

638.05

Are all steps present, stable and secure?

**638.08

If there are four or more steps, or the steps are 30”

or higher and one side of the steps is exposed

(open), is there one secure handrail with slats,

lattice, etc. to prevent a person from falling

through?

**638.09

If there are four or more steps, or the steps are 30”

or higher and both sides of the steps are exposed

(open), is there two secure handrails with slats,

lattice, etc. to prevent a person from falling

through?

PLUMBING AND HEATING

718.01

TYPE OF HEAT: GAS OR ELECTRIC

719.01

Is unit free of any unvented gas space heaters?

719.02

If there are flues or gas or wood stoves, are they

properly installed with secure pipes?

719.03

Are collars present and installed securely, with no

visible openings?

WATER HEATER

720.01

Is water heater GAS OR ELECTRIC?

**720.02

Is there a temperature pressure relief valve with a

3/4” overflow pipe?

720.03

Does the overflow pipe extend to within 6” of the

floor or to the exterior of the unit?

720.04

Gas water heater: Is the flue secure?

**720.05

Gas water heater: Is collar present and installed

securely, with no visible openings?

Revised 4/22/15

DIDD-0498 4

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

720.06

Gas water heater: If located in living or sleeping

area, is it enclosed? (an acceptable enclosure is a

“shield” that is secured to the wall or floor, provides

ventilation, and is at least 6” higher than the water

heater)

720.07

Electric water heater: If it is readily accessible to

the family, is the romex wire enclosed in protective

conduit?

720.08

Are there any hazardous or combustible materials

stored on top of or near the water heater?

720.09

Are cover panels present and securely installed?

721.01

Specify water System: (Circle) Public or Well

Water

721.02

If well water, is it tested every two years?

721.03

Any leaks, rust or corrosion in water, odors,

adequate pressure, or other problems?

722.01

Specify Sewer System: (Circle) Public or Septic

Tank

**722.02

If septic system, is there any evidence of water,

sewage in the yard, or does tenant report a

problem?

GENE RAL HEALTH AND SAFETY

824.02

If there are security bars on windows, does at least

one in each room without an exterior door open

from the inside?

824.03

If unit, is more than 2 stories in there a fire escape?

**825.01

For interior stairs and common halls if there are

four or more steps or the steps, balconies, or

ledges are 30” or higher, is there a secure

handrail?

838.05

Are all steps present, stable and secure?

825.02

For interior stairs and common halls is there

adequate lighting?

**825.03

For interior stairs and common halls is there any

hazardous or failing conditions in the walls, floors,

ceiling, windows or doors?

826.01

Where local practice requires, do all elevators have

a current inspection certificate? Are elevators safe

and working?

827.01

Is there evidence of insect, mice or rate

infestation?

828.01

Is the unit free from garbage and debris?

829.01

Is the unit free from any other hazards not

previously identified? Ex: protruding nails, broken

soap dishes, etc.

829.02

Are window air conditioners free of any exposed or

frayed wiring, or any other hazardous conditions?

829.03

Is cover present on window air conditioners?

829.04

Is window air conditioner installed in such a

manner that daylight cannot be seen above or

around it?

Revised 4/22/15

DIDD-0498 5

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

830.01

Unit free from abnormally high levels of air pollution

from vehicular exhaust, sewer gas, fuel gas, dust,

or other pollutants?

830.02

Does unit have adequate ventilation? NOTE:

Consider availability of air conditioning in each

room, number of operable windows in each room,

type of unit, etc., when making this decision.

831.01

Is there an emergency evacuation plan available in

the unit?

**832.01

Is there a smoke detector or fire alarm on each

level of the unit (including the basement)?

SMOKE DETECTORS FOR TH E HEARING

IMPAIRED

832.04

Does the smoke detector have lights, and is the

detector installed in the bedroom of the hearing

impaired tenant?

**832.05

Is there at least one fire extinguisher available on

every floor?

832.06

Is there a ventless gas heater being used in the

unit? Is there a carbon monoxide detector

present?

832.07

Is the carbon monoxide detector currently

operating (power on)?

BREAKER BOX

833.01

Is there a metal cover over fuse/breaker box?

**833.02

Are there any hazardous conditions inside or

around the fuse/breaker box? Ex: exposed or

frayed wiring of any type. Openings or holes

around the box, etc.

833.03

Are there any openings inside the fuse/breaker

box? NOTE: “knock-out” caps or “dead” fuses are

required. If openings are present inside.

GENERAL HEALTH AND SAFETY: Exterior

934.01

Are the grounds free of garbage and debris?

935.01

Are the covered trashcans or dumpsters for the

tenants’ use?

936.01

Are the site and immediate neighborhood free

from conditions which would seriously endanger

the health and safety of the residents such as

uncovered wells, deep holes, abandoned

appliances, abandoned cars, broken glass, etc.

936.02

Are all “out buildings” in sound condition?

BUILDING EXTERIOR (front, rear, and sides)

**1003.05

Do all permanently installed light fixtures have

covers, if designed to have covers? Front, Side,

Rear of unit

1009.02

Are all large exterior painted surfaces free of

deteriorated paint?

1037.01

Is the foundation free from large cracks, and does

it appear stable?

1037.02

Are all vents and crawl spaces covered?

**1038.01

Are all stairs, rails and porches secured?

**1038.05

Are steps present stable and secure?

Revised 4/22/15

DIDD-0498 6

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

Item #

Repair required/Comments

**1038.08

If there is a porch, balcony, carport, or any other

exposed area 30” or higher, is there a secure rail

with adequate protection (such as slats, lattice,

etc.) to prevent a person from falling through?

**1038.07

If there are four or more steps 29” or less in height,

is there at least one handrail?

**1038.09

If there are four or more steps, or the steps are 30”

or higher, and one side of the steps is exposed

(open), is there one secure handrail with adequate

protection (such as slats, lattice, etc.) to prevent a

person from falling through?

1038.10

If there is a sidewalk present, is it free from large

cracks or holes, and does it appear stable? (This

includes the driveway to the unit.)

1039.01

Any sign of roof damage or leaks?

1039.02

If gutters, downspouts, and shutters are present,

are they sound/secure?

1039.03

Any signs of leaks or drips from hydrants?

1040.01

Is exterior free from holes, missing siding, and

does it appear airtight?

1041.01

Is chimney sound, stable, and free from hazards?

1043.01

Do plumbing vent pipes extend above the roofline?

1043.02

Do gas or wood stove flues extend above the

roofline?

1043.03

Does the gas water heater flue extend above the

roofline?

**1044.01

Are there any loose, frayed, or exposed wires that

could be hazardous?

1045.01

If unit has window air conditioners, are they

installed securely?

MOB ILE HOME S

**1146.01

Are there tie downs? NOTE: If tie downs are

inaccessible by the inspector, please note in

comments.

1146.02

Is underpinning present: Is it installed securely

with no large openings?

**1146.03

Is unit free of ventless gas heater?

1148.04

If there is a wood burning stove present, is there a

permanently installed, primary source of heat?

NOTE: Wood burning stoves are not allowed as

the primary source of heat in a mobile home.

Revised 4/22/15

DIDD-0498 7