Housing Disrepair Audit Form

• Agent Name:

• Date

  Date

TENANT DETAILS

• Name:

• Date of Birth:

• Address:

• Occupation:

• Phone Number:

• Email:

• Ni Number:

• Photo ID:

  Media

• Proof of address:

  Media

• Other Occupants:

  Yes

  No

  N/A

TENANCY DETAILS

• Property type:

• Tenancy Type:

• Is the tenancy single or joint?

  Yes

  No

  N/A

• Are you named in the tenancy?

  Yes

  No

  N/A

• Did you pay a deposit?

  Yes

  No

  N/A

• How much?

• Benefits:

  Yes

  No

  N/A

• How much? Is it direct to landlord?

• Date Tenancy started:

• Do you have a copy of the tenancy agreement?

  Yes

  No

  N/A

• Rent Amount:

• How often is the rent paid?

  Monthly

  Every four weeks

  Fortnightly

  Every 2 weeks

• Rent Arrears

  Yes

  No

  N/A

• How much? Do you have a payment plan?

LANDLORD DETAILS

• Name

• Address

DEFECT DETAILS

• Why we believe this is a case

• Are the photos of the current state in your property?

  Yes

  No

  N/A

• Is there damp in the property?

  Yes

  No

  N/A

• If so, please give details

• How many rooms affected?

• Living Room

  Yes

  No

  N/A

• If so, please give details

• Dining Room

  Yes

  No

  N/A

• If so, please give details

• Kitchen

  Yes

  No

  N/A

• If so, please give details

• Bedroom 1

  Yes

  No

  N/A

• If so, please give details

• Bedroom 2

  Yes

  No

  N/A

• If so, please give details

• Bedroom 3

  Yes

  No

  N/A

• If so, please give details

• Bedroom 4

  Yes

  No

  N/A

• If so, please give details

• Bathroom

  Yes

  No

  N/A

• If so, please give details

• Are there any leaks in the property?

  Yes

  No

  N/A

• If so, please give details

• Is there loose or broken roof tiles?

  Yes

  No

  N/A

• If so, please give details

• Is there cracks to external walls?

  Yes

  No

  N/A

• If so, please give details

• Is there cracks to internal walls?

  Yes

  No

  N/A

• If so, please give details

• Are the doors or window frames rotting?<br>

  Yes

  No

  N/A

• If so, please give details

• Are there faulty electrics?

  Yes

  No

  N/A

• If so, please give details

• Is the boiler faulty?

  Yes

  No

  N/A

• If so, please give details

• Are any sanitary fixtures broken?

  Yes

  No

  N/A

• If so, please give details

• Are any floorboards roting?

  Yes

  No

  N/A

• If so, please give details

• Are there any vermin?

  Yes

  No

  N/A

• If so, please give details

• Is there any damage to the property?

  Yes

  No

  N/A

• If so, please give details

• Summary of Disrepair

• When was the disrepair first noticed?

  Date

• Has it been reported?

  Yes

  No

  N/A

• Date 1st Reported?

• Date last reported?

• Did the landlord respond?

  Yes

  No

  N/A

• How long since they last visited property?

• Details of complaint to landlord

• Do you have copies of the complaint correspondence?

  Yes

  No

  N/A

• Has landlord responded to complaints?

  Yes

  No

  N/A

• If so, please give details

• Has landlord made repairs?

  Yes

  No

  N/A

• If so, please give details

EFFECTS OF THE DISREPAIR

• Has the disrepair affected your routine?

  Yes

  No

  N/A

• If so, How?

• Has the disrepair affected your health?

  Yes

  No

  N/A

• If so, how?

• Has it affected other people in your household?

  Yes

  No

  N/A

• If so, please give details

• Has any personal property been damaged?

  Yes

  No

  N/A

• If so, please give details

  Yes

  No

  N/A

ADDITIONAL INFORMATION

• NOTES

Photos/ videos of disrepair

• Add images here

  Media