Title Page
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Conducted on
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Prepared by
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Location
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Name of Tenants.
Living Room
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Floor & Base boards
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Walls and ceilings
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Doors (locks and hardware)
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Light fixtures
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Windows and Screens
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Smoke / CO Alarm
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Outlets and cover plates
Kitchen and Dining nook
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Floor & Base boards
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Counter & surfaces
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Walls and ceilings
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Sliding door (lock and hardware)
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Light fixtures
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Windows and Screens
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Cabinents / inside drawers
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Stove / Burners and controls
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Oven / range hood inside, outside and fan.
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Microwave, operational (light and fan)
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Refrigerator
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Dishwasher
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Sinks and plumbing
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Garbage disposal
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Fire Extinguisher
Bedroom 1
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Closet (closet system)
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Fan and light fixture
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Smoke alarms
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Outlets and cover plates
Bedroom 2
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Closet (closet system)
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Fan and light fixture
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Smoke alarms
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Outlets and cover plates
Bedroom 3
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Closet (closet system)
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Fan and light fixture
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Smoke alarms
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Outlets and cover plates
Bedroom 4
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Closet (closet system)
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Fan and light fixture
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Smoke alarms
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Outlets and cover plates
Master bath
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Fan and light fixture
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Outlets and cover plates
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Counters & Surfaces
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Sink and Plumbing
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Bathtub / Shower (curtain bar)
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Toilet
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Inside drawers.
2nd bath
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Door and hardware
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Floor and Baseboards
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Walls and ceilings
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Windows and screens
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Fan and light fixture
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Outlets and cover plates
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Counters & Surfaces
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Sink and Plumbing
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Bathtub / Shower (curtain bar)
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Toilet
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Inside drawers.
Hall
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Empty attic space
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Floor and Baseboards
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Walls and ceilings
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recess lights
Garage
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Clean and Empty
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Door and lock
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Walls and ceilings
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Lights and outlets
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Garage bay door (opens and operates with remotes)
Other
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HVAC / Filter
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Water Heater
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Lawn and Garden
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Front Porch
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Back Patio
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House exterior
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Garden Shed
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Number of Keys Received
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Number of Garage Openers Given
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Tenants Acknowledge that all smoke alarms, carbon monoxide alarms, and fire extinguishers were tested in their presence and found to be in working order and that the testing procedure was explained to them. Tenants agree to test all detectors at least once a month and to report any problems to the landlord / Manager in writing as soon as discovered.
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Landlord / Manager signature
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Tenant signature 1
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Tenant signature 2
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Tenant signature 3
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Tenant signature 4