Title Page

  • Conducted on

  • Prepared by

  • Customer Name

  • Location

Customer Details

  • Customer Title and Full Name (including any middle names)

  • Customer Home Phone Number

  • Customer Mobile Phone Number

  • Customer Email

  • Customer Address (incl post code)
  • Customer Date of Birth

  • Tenancy (Single/Joint)

  • Tenancy Type (C/HA/P)

Tenancy Details

  • Date Tenancy Started

  • Can you provide a copy of your tenancy agreement?

  • How much is your rent? (amount and frequency)

  • Are you in arrears with your rent?

  • Value of arrears (£)

  • Name of Landlord

  • Landlord phone number

  • Landlord Email

  • Landlord Address

  • Type of Property

Defect Details

  • Please describe the property defects in detail

  • When did you notice the defect? (date)

  • How many rooms does the defect affect?

  • Have you reported this to the landlord?

  • What date did you report this to your landlord?

  • Did your landlord respond? If so provide dates and details of what was communicated.

  • Provide photo evidence of the landlord correspondence if possible

  • How many times have you contacted the landlord regarding the defects?

  • Provide a list of dates and correspondence details sent to the landlord if possible

  • Describe in detail how the defects are affecting you and your family's daily routine.

  • Has your health been affected by the defects?

  • Have any of your family members' health been affected by the defects

  • Please provide names and dates of birth of those affected

  • Please detail the symptoms each of those affected are suffering

  • Have you sought medical attention regarding the heath issues experienced?

  • Have any of your belongings been damaged by the defect/s to the property

  • If yes, please provide details of the items, how they have been damaged and the cost of the item.

Property photos and media

  • Upload full photographic evidence of the defects to the property

  • Upload video of property damage

  • Assessors Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.