Title Page
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Site conducted
-
Client's Name
-
Address
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Home Facing(direction) N-S-E-W
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Building Type(i.e. mobile, bungalow)
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Year Built
-
Number of bedroom
-
Prepared by
-
Conducted on
Exterior
-
Skirting (mobile homes)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Anchorage (mobile homes)
-
Driveways / Parking
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Walkways
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Water storage / Septic tanks / Oil Tank
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Grade (Around Foundation)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Foundation (Above Grade)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Cladding / Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Trim (corner, door & window)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flashing (Windows / Doors / Siding / Wall Finish)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Vent Hoods
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Soffits / Fascia / Flashing
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Electrical outlet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Meter Socket/Mast
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Hose Bib
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Eavestroughs / Downspouts / Splashpads
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Roofing
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Roof Vents, Plumbing Vents, Flashings
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Chimney
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Attic Access
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Attic insulation
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Attic ventilation
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Entrances
Main Entrance
-
Location
-
Entrance door
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Hand/Guard Rail
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Steps/Landings
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Deck/Balcony
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Secondary Entrance
-
Location
-
Entrance Door
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Hand/Guard rail
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Steps/Landings
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Deck/Balcony
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Basement/Crawlspace
-
Stairs / Handrails / Entrance
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Basement / Crawl Space Floor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Perimeter/Rim Joist Insulation
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Foundation Walls / Grade beam
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Columns / Beams / Joists
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ventilation
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Evidence of Water / Moisture Infiltration
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Switches / Receptacles
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Systems- Heat/Ventilation, Plumbing, Electrical
-
Primary Heat Source - LIST AGE, FUEL TYPE & BTU'S
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Secondary Heat Source (if applicable) – LIST AGE, FUEL TYPE, BTU'S
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Date Last Serviced (if known)
-
Heat Distribution System
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
HRV/ Air Exchanger
-
Clearance to Combustibles
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
Systems- Plumbing/Sewer
-
Sump Pump / Pit
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Water / Sewage pumps
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Hot Water Tank – LIST AGE, SIZE
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Drain / Supply lines
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
System- Electrical
-
Smoke Detector / CO Detector
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Electrical Panel
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Interior
Main entrance/Porch area
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles / switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Kitchen
-
Cabinets/Countertops / Backsplash
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Sink / Faucets
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring / Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles / Switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
GFCI
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Range Hood
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Living Room and Hallway
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Switches / Receptacles
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Door
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bathroom 1
-
Location
-
Vanity
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Sink / Faucet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
GFCI Plug
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Water Closet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub / Shower / Faucets
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub Surround / Enclosure
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Exhaust Fan
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures/switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bathroom 2
-
Location
-
Vanity
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Sink / Faucet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
GFCI Plug
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Water Closet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub / Shower / Faucets
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub Surround / Enclosure
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Exhaust Fan
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures/switches/
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bathroom 3
-
Location
-
Vanity
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Sink / Faucet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
GFCI Plug
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Water Closet
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub / Shower / Faucets
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Tub Surround / Enclosure
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Exhaust Fan
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures/switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bedroom 1
-
Location
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Closet / Shelving
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles / switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Doors
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bedroom 2
-
Location
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Closet / Shelving
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles / switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Doors
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bedroom 3
-
Location
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Closet / Shelving
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures / switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Doors
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Bedroom 4
-
Location
-
Flooring/Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Windows (with # to be replaced)
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Closet / Shelving
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Receptacles
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Light fixtures / switches
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Doors
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Interior - General
-
Stairs / Handrails
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Ceiling Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Wall Finish
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Flooring / Subfloor
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Built-In Closets / Storage / Shelves
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Evidence of Water / Moisture Infiltration
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
-
Other
- Urgent, Immediate
- Short term within 1 year
- Medium Term 1 to 3 years
- Long Term 3 to 5 Years
- Adequate more than 5 years
- Not Applicable
Overall condition of Home
-
Overall condition of Home
-
Would the cost of repairs be estimated at 75% or more of a replacement cost?
-
Disability/Accessibility
-
To the best of your knowledge, do any of the occupants have a physical or cognitive disability? If yes, please describe and provide recommended accessibility improvements:
-
Comments
-
Inspector Name:
-
Inspector Phone #:
-
Inspection Date:
-
Chester Brucks