NSPIRE HUD Checklist - Template

• Inspection Date

  Date

• Inspector

  Select Paul Bearce Jose Sanchez Mike Moroni Wayne Newbury Mark Hanson Derrick Miller David Geier Geraldo Ruiz Anderson Ducot Ken Douglas Johan Hernandez Hilario Avila

  • Paul Bearce
  • Jose Sanchez
  • Mike Moroni
  • Wayne Newbury
  • Mark Hanson
  • Derrick Miller
  • David Geier
  • Geraldo Ruiz
  • Anderson Ducot
  • Ken Douglas
  • Johan Hernandez
  • Hilario Avila

Site Info

• Property

  Select Beechwood Gardens Cedar Court Mohegan Commons Moosup Gardens Trackside Windham Heights Winthrop Square

  • Beechwood Gardens
  • Cedar Court
  • Mohegan Commons
  • Moosup Gardens
  • Trackside
  • Windham Heights
  • Winthrop Square

• Unit

NSPIRE Inspection Deficiencies

Address and signage

• Is there an address and signage deficiency

  Yes

  No

  N/A

• Name the deficiency

  Select Address, signage, or building identification codes are broken, illegible, or not visible.

  • Address, signage, or building identification codes are broken, illegible, or not visible.
Bathtub & shower

• Bathtub/shower deficiency

  Select Only 1 bathtub or shower is present and it is inoperable or does not drain. A bathtub or shower is inoperable or does not drain and at least 1 bathtub or shower is present elsewhere that is operational. Bathtub component or shower component is damaged, inoperable, or missing such that it may limit the resident's ability to maintain personal hygiene. Bathtub component or shower component is damaged, inoperable, or missing and it does not limit the resident's ability to maintain personal hygiene. Bathtub or shower cannot be used in private.* N/A

  • Only 1 bathtub or shower is present and it is inoperable or does not drain.
  • A bathtub or shower is inoperable or does not drain and at least 1 bathtub or shower is present elsewhere that is operational.
  • Bathtub component or shower component is damaged, inoperable, or missing such that it may limit the resident's ability to maintain personal hygiene.
  • Bathtub component or shower component is damaged, inoperable, or missing and it does not limit the resident's ability to maintain personal hygiene.
  • Bathtub or shower cannot be used in private.*
  • N/A

Cabinet & storage

• Cabinet & Storage Deficiency

  Select Food storage space is not present.* Storage component is damaged, inoperable, or missing. N/A

  • Food storage space is not present.*
  • Storage component is damaged, inoperable, or missing.
  • N/A

Call for aid deficiencies

• Name the Call for aid deficiencies

  Select System is blocked, or pull cord is higher than 6 inches off the floor. System does not function properly. N/A

  • System is blocked, or pull cord is higher than 6 inches off the floor.
  • System does not function properly.
  • N/A

• Location?

  Select Bedroom 1 Bedroom 2 Bathroom 1 Bathroom 2

  • Bedroom 1
  • Bedroom 2
  • Bathroom 1
  • Bathroom 2

Carbon monoxide deficiencies

• CO deficiencies

  Select Carbon monoxide alarm is missing, not installed, or not installed in a proper location.* Carbon monoxide alarm is obstructed. Carbon monoxide alarm does not produce an audio or visual alarm when tested. N/A

  • Carbon monoxide alarm is missing, not installed, or not installed in a proper location.*
  • Carbon monoxide alarm is obstructed.
  • Carbon monoxide alarm does not produce an audio or visual alarm when tested.
  • N/A

• Location

  Select Basement Living Room 1st Level Hallway 2nd Level Hallway Outside of Bedrooms Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4

  • Basement
  • Living Room
  • 1st Level Hallway
  • 2nd Level Hallway Outside of Bedrooms
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4

Ceiling Deficiencies

• Name the ceiling deficiency

  Select Ceiling has an unstable surface. Ceiling has a hole. Ceiling component(s) is not functionally adequate. N/A

  • Ceiling has an unstable surface.
  • Ceiling has a hole.
  • Ceiling component(s) is not functionally adequate.
  • N/A

• Location(s)?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Chimney Deficiencies

• Chimney deficiency

  Select A visually accessible chimney, flue, or firebox connected to a fireplace or wood-burning appliance is incomplete or damaged such that it may not safely contain fire and convey smoke and combustion gases to the exterior. Chimney exhibits signs of structural failure. N/A

  • A visually accessible chimney, flue, or firebox connected to a fireplace or wood-burning appliance is incomplete or damaged such that it may not safely contain fire and convey smoke and combustion gases to the exterior.
  • Chimney exhibits signs of structural failure.
  • N/A

Clothes dryer exhaust deficiency

• Clothes dryer exhaust deficiency

  Select Electric dryer transition duct is detached or missing. Gas dryer transition duct is detached or missing. Electric dryer exhaust ventilation system has restricted airflow. Dryer transition duct is constructed of unsuitable material. Gas dryer exhaust ventilation system has restricted airflow. Exterior dryer vent cover, cap, or a component thereof is missing. N/A

  • Electric dryer transition duct is detached or missing.
  • Gas dryer transition duct is detached or missing.
  • Electric dryer exhaust ventilation system has restricted airflow.
  • Dryer transition duct is constructed of unsuitable material.
  • Gas dryer exhaust ventilation system has restricted airflow.
  • Exterior dryer vent cover, cap, or a component thereof is missing.
  • N/A

• Location?

  Laundry Center

  Kitchen

  Basement

Cooking appliance deficiency

• Name the cooking appliance deficiency

  Select Cooking range, cooktop, or oven does not ignite or produce heat. Cooking range, cooktop, or oven component is damaged or missing such that the device is unsafe for use. Primary cooking appliance is missing.* A microwave is the primary cooking appliance and it is damaged. A burner does not produce heat, but at least 1 other burner is present on the cooking range or cooktop and does produce heat. N/A

  • Cooking range, cooktop, or oven does not ignite or produce heat.
  • Cooking range, cooktop, or oven component is damaged or missing such that the device is unsafe for use.
  • Primary cooking appliance is missing.*
  • A microwave is the primary cooking appliance and it is damaged.
  • A burner does not produce heat, but at least 1 other burner is present on the cooking range or cooktop and does produce heat.
  • N/A
Door - Entry

• Entry door deficiency

  Select Entry door will not open. Entry door will not close. Entry door self-closing mechanism is damaged, inoperable, or missing. Hole, split, or crack that penetrates completely through entry door. Entry door is missing. Entry door surface is delaminated or separated. Entry door frame, threshold, or trim is damaged or missing. Entry door seal, gasket, or stripping is damaged, inoperable, or missing. Entry door component is damaged, inoperable, or missing and it does not limit the door’s ability to provide privacy or protection from weather or infestation. Entry door cannot be secured. N/A

  • Entry door will not open.
  • Entry door will not close.
  • Entry door self-closing mechanism is damaged, inoperable, or missing.
  • Hole, split, or crack that penetrates completely through entry door.
  • Entry door is missing.
  • Entry door surface is delaminated or separated.
  • Entry door frame, threshold, or trim is damaged or missing.
  • Entry door seal, gasket, or stripping is damaged, inoperable, or missing.
  • Entry door component is damaged, inoperable, or missing and it does not limit the door’s ability to provide privacy or protection from weather or infestation.
  • Entry door cannot be secured.
  • N/A

• Location(s)

  Select Front Rear

  • Front
  • Rear
Door - Fire

• Fire door deficiency

  Select Fire labeled door does not open. Fire labeled door does not close and latch or the self-closing hardware is damaged or missing such that the door does not self-close and latch. Fire labeled door assembly has a hole of any size or is damaged such that its integrity may be compromised. Fire labeled door seal or gasket is damaged or missing. An object is present that may prevent the fire labeled door from closing and latching or self-closing and latching. Fire labeled door cannot be secured. Fire labeled door is missing. N/A

  • Fire labeled door does not open.
  • Fire labeled door does not close and latch or the self-closing hardware is damaged or missing such that the door does not self-close and latch.
  • Fire labeled door assembly has a hole of any size or is damaged such that its integrity may be compromised.
  • Fire labeled door seal or gasket is damaged or missing.
  • An object is present that may prevent the fire labeled door from closing and latching or self-closing and latching.
  • Fire labeled door cannot be secured.
  • Fire labeled door is missing.
  • N/A

• Location(s)? (Add nearest apartment)

  Select 1st floor stairwell 2nd floor stairwell 3rd floor stairwell Basement stairwell Basement boiler room Basement storage room

  • 1st floor stairwell
  • 2nd floor stairwell
  • 3rd floor stairwell
  • Basement stairwell
  • Basement boiler room
  • Basement storage room

Door - general

• General door deficiency

  Select A passage door does not open. A passage door component is damaged, inoperable, or missing and the door is not functionally adequate. A door that is not intended to permit access between rooms has a damaged, inoperable, or missing component. An exterior door component is damaged, inoperable, or missing. N/A

  • A passage door does not open.
  • A passage door component is damaged, inoperable, or missing and the door is not functionally adequate.
  • A door that is not intended to permit access between rooms has a damaged, inoperable, or missing component.
  • An exterior door component is damaged, inoperable, or missing.
  • N/A

• Location

  Select Bath 1 Bath 2 Bedroom 1 door Bedroom 1 closet Bedroom 2 door Bedroom 2 closet Bedroom 3 door Bedroom 3 closet Bedroom 4 Door Bedroom 4 closet Building Exterior Door (Add Area Located In Notes) N/A

  • Bath 1
  • Bath 2
  • Bedroom 1 door
  • Bedroom 1 closet
  • Bedroom 2 door
  • Bedroom 2 closet
  • Bedroom 3 door
  • Bedroom 3 closet
  • Bedroom 4 Door
  • Bedroom 4 closet
  • Building Exterior Door (Add Area Located In Notes)
  • N/A

Drain

• Drain Deficiency

  Drain is fully blocked.

  N/A

• Location

  Select Bath Sink Bath Tub Kitchen Sink Laundry room Basement Hallway

  • Bath Sink
  • Bath Tub
  • Kitchen Sink
  • Laundry room
  • Basement
  • Hallway

Egress

• Egress deficiency?

  Select Obstructed means of egress. Sleeping room is located on the 3rd floor or below and has an obstructed rescue opening. Fire escape access is obstructed. N/A

  • Obstructed means of egress.
  • Sleeping room is located on the 3rd floor or below and has an obstructed rescue opening.
  • Fire escape access is obstructed.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Electrical Conductor, Outlet, Switch

• Electrical conductor deficiency

  Select Outlet or switch is damaged. Testing indicates a three-pronged outlet is not properly wired or grounded. Outlet does not have visible damage and testing indicates it is not energized. Exposed electrical conductor. Water is currently in contact with an electrical conductor. N/A

  • Outlet or switch is damaged.
  • Testing indicates a three-pronged outlet is not properly wired or grounded.
  • Outlet does not have visible damage and testing indicates it is not energized.
  • Exposed electrical conductor.
  • Water is currently in contact with an electrical conductor.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Electrical - GFCI - AFCI

• Name the GFCI/AFCI deficiency

  Select GFCI outlet or GFCI breaker is not visibly damaged and the test or reset button is inoperable. AFCI outlet or AFCI breaker is not visibly damaged and the test or reset button is inoperable. An unprotected outlet is present within six feet of a water source.* N/A

  • GFCI outlet or GFCI breaker is not visibly damaged and the test or reset button is inoperable.
  • AFCI outlet or AFCI breaker is not visibly damaged and the test or reset button is inoperable.
  • An unprotected outlet is present within six feet of a water source.*
  • N/A

• Location

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Electrical Service Panel

• Electrical panel deficiency

  Select Electrical service panel is not readily accessible. The overcurrent protection device is damaged. The overcurrent protection device is contaminated. N/A

  • Electrical service panel is not readily accessible.
  • The overcurrent protection device is damaged.
  • The overcurrent protection device is contaminated.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Elevator Deficiencies

• Elevator deficiencies

  Select Elevator is inoperable. Elevator door does not fully open and close. Elevator cab is not level with the floor. Safety edge device has malfunctioned or is inoperable. N/A

  • Elevator is inoperable.
  • Elevator door does not fully open and close.
  • Elevator cab is not level with the floor.
  • Safety edge device has malfunctioned or is inoperable.
  • N/A

Exit sign deficiency

• Exit Sign Deficiency

  Select Exit sign is damaged, missing, obstructed, or not adequately illuminated. N/A

  • Exit sign is damaged, missing, obstructed, or not adequately illuminated.
  • N/A

• Location? (Add nearest unit number)

  1st Floor

  2nd floor

  3rd floor

  4th floor

  Other

Fence & Gate Deficiencies

• Name the fence/gate deficiencies

  Select Fence component is missing. Gate does not open, close, latch, or lock. Fence demonstrates signs of collapse. N/A

  • Fence component is missing.
  • Gate does not open, close, latch, or lock.
  • Fence demonstrates signs of collapse.
  • N/A

• Closest Unit

Fire Escape

• Fire escape component is damaged or missing?

  Yes

  No

  N/A

• Location or level?

  Select 1st Floor 2nd floor 3rd floor 4th floor Other

  • 1st Floor
  • 2nd floor
  • 3rd floor
  • 4th floor
  • Other

Fire Extinguisher

• Name the fire extinguisher deficiencies

  Select Fire extinguisher pressure gauge reads over or under-charged. Fire extinguisher service tag is missing, illegible, or expired. Fire extinguisher is damaged or missing. N/A

  • Fire extinguisher pressure gauge reads over or under-charged.
  • Fire extinguisher service tag is missing, illegible, or expired.
  • Fire extinguisher is damaged or missing.
  • N/A

• Location?

Flammable and combustible items

• Combustible Deficiencies

  Select "Flammable or combustible item is on or within 3 feet of an appliance that provides heat for thermal comfort or a fuel-burning water heater. Improperly stored chemicals." N/A

  • "Flammable or combustible item is on or within 3 feet of an appliance that provides heat for thermal comfort or a fuel-burning water heater.
  • Improperly stored chemicals."
  • N/A

• Location

Floor

• Floor deficiencies

  Select Floor substrate is exposed. Floor component(s) is not functionally adequate. N/A

  • Floor substrate is exposed.
  • Floor component(s) is not functionally adequate.
  • N/A

Food preparation

• Food preparation deficiencies

  Select Food preparation area is not present.* Food preparation area is damaged or is not functionally adequate. N/A

  • Food preparation area is not present.*
  • Food preparation area is damaged or is not functionally adequate.
  • N/A

Foundation Deficiencies

• Foundation deficiencies (Add location in notes)

  Select Foundation is cracked. Foundation has exposed rebar or foundation is spalling, flaking, or chipping. Foundation is infiltrated by water. Foundation support post, column, beam, or girder is damaged. Foundation vent cover is missing or damaged. N/A

  • Foundation is cracked.
  • Foundation has exposed rebar or foundation is spalling, flaking, or chipping.
  • Foundation is infiltrated by water.
  • Foundation support post, column, beam, or girder is damaged.
  • Foundation vent cover is missing or damaged.
  • N/A

Garage Door

• Garage door deficiency

  Select Garage door has a hole. Garage door does not open, close, or remain open or closed. N/A

  • Garage door has a hole.
  • Garage door does not open, close, or remain open or closed.
  • N/A

Guard Rail

• Guard rail deficiencies

  Select Grab bar is not secure. Guardrail is missing or not installed.* Guardrail is not functionally adequate. N/A

  • Grab bar is not secure.
  • Guardrail is missing or not installed.*
  • Guardrail is not functionally adequate.
  • N/A

Handrail

• Handrail Deficiencies

  Select Handrail is missing. Handrail is not secure. Handrail is not functionally adequate. Handrail is not installed where required. N/A

  • Handrail is missing.
  • Handrail is not secure.
  • Handrail is not functionally adequate.
  • Handrail is not installed where required.
  • N/A

HVAC

• HVAC Deficiency

  Select The inspection date is on or between October 1 and March 31 and the permanently installed heating source is not working or the permanently installed heating source is working and the interior temperature is below 64 degrees Fahrenheit.* The inspection date is on or between October 1 and March 31 and the permanently installed heating source is working and the interior temperature is 64 to 67.9 degrees Fahrenheit.* Air conditioning system or device is not operational. Unvented space heater that burns gas, oil, or kerosene is present.* Combustion chamber cover or gas shutoff valve is missing from a fuel burning heating appliance. The inspection date is on or between April 1 and September 30 and a permanently installed heating source is damaged, inoperable, missing, or not installed.* Fuel burning heating system or device exhaust vent is misaligned, blocked, disconnected, improperly connected, damaged, or missing. The inspection date is on or between October 1 and March 31 and the permanently installed heating source is inoperable. Heating system or device safety shield is damaged or missing. N/A

  • The inspection date is on or between October 1 and March 31 and the permanently installed heating source is not working or the permanently installed heating source is working and the interior temperature is below 64 degrees Fahrenheit.*
  • The inspection date is on or between October 1 and March 31 and the permanently installed heating source is working and the interior temperature is 64 to 67.9 degrees Fahrenheit.*
  • Air conditioning system or device is not operational.
  • Unvented space heater that burns gas, oil, or kerosene is present.*
  • Combustion chamber cover or gas shutoff valve is missing from a fuel burning heating appliance.
  • The inspection date is on or between April 1 and September 30 and a permanently installed heating source is damaged, inoperable, missing, or not installed.*
  • Fuel burning heating system or device exhaust vent is misaligned, blocked, disconnected, improperly connected, damaged, or missing.
  • The inspection date is on or between October 1 and March 31 and the permanently installed heating source is inoperable.
  • Heating system or device safety shield is damaged or missing.
  • N/A

Infestation

• Infestation Deficiency

  Select Evidence of cockroaches. Extensive cockroach infestation. Evidence of bedbugs. Extensive bedbug infestation. Evidence of mice. Extensive mouse infestation. Evidence of rats. Extensive rat infestation. Evidence of other pests.

  • Evidence of cockroaches.
  • Extensive cockroach infestation.
  • Evidence of bedbugs.
  • Extensive bedbug infestation.
  • Evidence of mice.
  • Extensive mouse infestation.
  • Evidence of rats.
  • Extensive rat infestation.
  • Evidence of other pests.

Leak - Gas/Oil

• Natural Gas, Propane, or Oil Leak

  Yes

  No

  N/A

Leak - Sewage

• Leak Sewage Deficiency

  Select Blocked sewage system. Leak in sewage system. Cap to the cleanout or pump cover is detached or missing. Cleanout cap or riser is damaged.

  • Blocked sewage system.
  • Leak in sewage system.
  • Cap to the cleanout or pump cover is detached or missing.
  • Cleanout cap or riser is damaged.

Leak - Water

• Leak - Water Deficiencies

  Select Environmental water intrusion. Plumbing leak. Fluid is leaking from the sprinkler assembly.

  • Environmental water intrusion.
  • Plumbing leak.
  • Fluid is leaking from the sprinkler assembly.

Lighting Auxiliary

• Auxiliary lighting is damaged, missing, or fails to illuminate when tested.

  Yes

  No

  N/A

Lighting Exterior

• A permanently installed light fixture is damaged, inoperable, missing, or not secure.

  Yes

  No

  N/A

Lighting Interior

• Lighting - Interior Deficiencies

  Select A permanently installed light fixture is inoperable. A permanently installed light fixture is not secure. At least one (1) permanently installed light fixture is not present in the kitchen and bathroom.* N/A

  • A permanently installed light fixture is inoperable.
  • A permanently installed light fixture is not secure.
  • At least one (1) permanently installed light fixture is not present in the kitchen and bathroom.*
  • N/A

Litter

• Litter Deficiency Present?

  Yes

  No

  N/A

Minimum Electrical & Lighting

• At least two (2) working outlets are not present within each habitable room. OR At least one (1) working outlet and one (1) permanently installed light fixture is not present within each habitable room.*

  Yes

  No

  N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Mold Like Substances

• Mold Deficiencies

  Select Presence of mold-like substance at moderate levels is observed visually. Presence of mold-like substance at high levels is observed visually. Presence of mold-like substance at extremely high levels is observed visually. Elevated moisture level. N/A

  • Presence of mold-like substance at moderate levels is observed visually.
  • Presence of mold-like substance at high levels is observed visually.
  • Presence of mold-like substance at extremely high levels is observed visually.
  • Elevated moisture level.
  • N/A

• Location

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Potential Lead-Based Paint Hazards - Visual Assessment

• Paint Deficiencies

  Select Paint in a Unit or Inside the target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance. Paint in a Unit or Inside the target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance. Paint Outside on a target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance. Paint Outside on a target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance.

  • Paint in a Unit or Inside the target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance.
  • Paint in a Unit or Inside the target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance.
  • Paint Outside on a target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance.
  • Paint Outside on a target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance.

Parking Lot

• Parking Lot Deficiencies

  Select Parking lot has any one pothole that is 4 inches deep and 1 square foot or greater. Parking lot has ponding. N/A

  • Parking lot has any one pothole that is 4 inches deep and 1 square foot or greater.
  • Parking lot has ponding.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Potential Lead-Based Paint Hazards - Visual Assessment

• Potential Lead-Based Paint Hazards - Visual Assessment - Deficiency

  Select Paint in a Unit or Inside the target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance. Paint in a Unit or Inside the target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance. Paint Outside on a target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance. Paint Outside on a target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance. N/A

  • Paint in a Unit or Inside the target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance.
  • Paint in a Unit or Inside the target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance.
  • Paint Outside on a target property is deteriorated – below the level required for lead-safe work practices by a lead-certified firm or for passing clearance.
  • Paint Outside on a target property is deteriorated – above the level required for lead-safe work practices by a lead-certified firm and passing clearance.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Private Roads and Driveways

• Private Roads and Driveways - Deficiencies

  Select Road or driveway access to the property is blocked or impassable for vehicles. Road or driveway has any one pothole that is 4 inches deep and 1 square foot or greater. N/A

  • Road or driveway access to the property is blocked or impassable for vehicles.
  • Road or driveway has any one pothole that is 4 inches deep and 1 square foot or greater.
  • N/A

Refrigerator

• Refrigerator Deficiency

  Select Refrigerator is inoperable such that it may be unable to safely and adequately store food. Refrigerator component is damaged such that it impacts functionality. Refrigerator is missing.* N/A

  • Refrigerator is inoperable such that it may be unable to safely and adequately store food.
  • Refrigerator component is damaged such that it impacts functionality.
  • Refrigerator is missing.*
  • N/A

Retaining Wall

• Retaining Wall Deficiency

  Select Retaining wall is leaning away from the fill side. Retaining wall is partially or completely collapsed. N/A

  • Retaining wall is leaning away from the fill side.
  • Retaining wall is partially or completely collapsed.
  • N/A

Roof Assembly

• Roof Assembly Deficiencies

  Select Restricted flow of water from a roof drain, gutter, or downspout. Gutter component is damaged, missing, or unfixed. Roof surface has standing water. Substrate is exposed. Roof assembly has a hole. Roof assembly is damaged. N/A

  • Restricted flow of water from a roof drain, gutter, or downspout.
  • Gutter component is damaged, missing, or unfixed.
  • Roof surface has standing water.
  • Substrate is exposed.
  • Roof assembly has a hole.
  • Roof assembly is damaged.
  • N/A

• Location?

Sharp Edges

• Sharp Edge is present

  Yes

  No

  N/A

• Location

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Sidewalk - Walkway - Ramp

• Sidewalk - Walkway - Ramp Deficiency

  Select Sidewalk, walkway, or ramp is blocked or impassable. Sidewalk, walkway, or ramp is not functionally adequate. N/A

  • Sidewalk, walkway, or ramp is blocked or impassable.
  • Sidewalk, walkway, or ramp is not functionally adequate.
  • N/A

• Location or Area

Sink

• Sink Deficiency

  Select Sink or sink component is damaged or missing and the sink is not functionally adequate. Water is directed outside of the basin. Sink is not draining. Sink is improperly installed, pulling away from the wall, leaning, or there are gaps between the sink and wall. Sink component is damaged or missing and the sink is functionally adequate. Cannot activate or deactivate hot and cold water.* Sink is missing or not installed within the primary kitchen.* N/A

  • Sink or sink component is damaged or missing and the sink is not functionally adequate.
  • Water is directed outside of the basin.
  • Sink is not draining.
  • Sink is improperly installed, pulling away from the wall, leaning, or there are gaps between the sink and wall.
  • Sink component is damaged or missing and the sink is functionally adequate.
  • Cannot activate or deactivate hot and cold water.*
  • Sink is missing or not installed within the primary kitchen.*
  • N/A

• Location?

  Select Kitchen Bathroom

  • Kitchen
  • Bathroom

Site Drainage

• Site Drainage Deficiency

  Select Water runoff is unable to flow through the site drainage system. Erosion is present. Grate is not secure or does not cover the site drainage system’s collection point. N/A

  • Water runoff is unable to flow through the site drainage system.
  • Erosion is present.
  • Grate is not secure or does not cover the site drainage system’s collection point.
  • N/A

• Location?

Smoke Alarm

• Smoke Alarm Deficiency

  Select Smoke alarm is not installed where required.* Smoke alarm is obstructed. Smoke alarm does not produce an audio or visual alarm when tested. N/A

  • Smoke alarm is not installed where required.*
  • Smoke alarm is obstructed.
  • Smoke alarm does not produce an audio or visual alarm when tested.
  • N/A

• Location

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Sprinkler Assembly

• Sprinkler Assembly

  Select Sprinkler head assembly is encased or obstructed by an item or object that is within 18 inches of the sprinkler head. Sprinkler assembly component is damaged, inoperable, or missing and it is detrimental to performance. Sprinkler assembly has evidence of corrosion. Sprinkler assembly has evidence of foreign material that is detrimental to performance. N/A

  • Sprinkler head assembly is encased or obstructed by an item or object that is within 18 inches of the sprinkler head.
  • Sprinkler assembly component is damaged, inoperable, or missing and it is detrimental to performance.
  • Sprinkler assembly has evidence of corrosion.
  • Sprinkler assembly has evidence of foreign material that is detrimental to performance.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Stairs

• Stair Deficiency

  Select Tread is missing or damaged. Stringer is damaged. N/A

  • Tread is missing or damaged.
  • Stringer is damaged.
  • N/A

• Location

Steps and Stairs

• Step or stair is not functionally adequate.

  Yes

  No

  N/A

• Location

Structure

• Structural system exhibits signs of serious failure.

  Yes

  No

  N/A
Toilet

• Toilet Deficiencies

  Select Only 1 toilet was installed, and it is missing. A toilet is missing and at least 1 toilet is installed elsewhere that is operational. Only 1 toilet was installed, and it is damaged or inoperable. A toilet is damaged or inoperable and at least 1 toilet is installed elsewhere that is operational. Toilet component is damaged, inoperable, or missing such that it may limit the resident’s ability to safely discharge human waste. Toilet is not secured at the base. Toilet component is damaged, inoperable, or missing and it does not limit the resident’s ability to discharge human waste. Toilet cannot be used in private.* N/A

  • Only 1 toilet was installed, and it is missing.
  • A toilet is missing and at least 1 toilet is installed elsewhere that is operational.
  • Only 1 toilet was installed, and it is damaged or inoperable.
  • A toilet is damaged or inoperable and at least 1 toilet is installed elsewhere that is operational.
  • Toilet component is damaged, inoperable, or missing such that it may limit the resident’s ability to safely discharge human waste.
  • Toilet is not secured at the base.
  • Toilet component is damaged, inoperable, or missing and it does not limit the resident’s ability to discharge human waste.
  • Toilet cannot be used in private.*
  • N/A

• Which Bathroom?

  Select Bath 1 Bath 2 Bath 3 Other N/A

  • Bath 1
  • Bath 2
  • Bath 3
  • Other
  • N/A
Trash Chute

• Trash Chute Deficiency

  Select Chute door does not open or self-close and latch. Chute is clogged. N/A

  • Chute door does not open or self-close and latch.
  • Chute is clogged.
  • N/A

• Floor?

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

Trip Hazard

• Trip Hazard Deficiency Present

  Yes

  No

  N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Ventilation

• Ventilation Deficiency

  Select Exhaust system does not respond to the control switch. Exhaust system has restricted airflow. Exhaust system component is damaged or missing. Bathroom does not have proper ventilation or dehumidification. N/A

  • Exhaust system does not respond to the control switch.
  • Exhaust system has restricted airflow.
  • Exhaust system component is damaged or missing.
  • Bathroom does not have proper ventilation or dehumidification.
  • N/A

Wall Exterior

• Wall Exterior Deficiency

  Select Exterior wall covering has missing sections of at least 1 square foot per wall. Exterior wall has peeling paint of 10 square feet or more. Exterior wall component(s) is not functionally adequate. N/A

  • Exterior wall covering has missing sections of at least 1 square foot per wall.
  • Exterior wall has peeling paint of 10 square feet or more.
  • Exterior wall component(s) is not functionally adequate.
  • N/A

• Location?

  Front of building

  Rear of building

  Left side of building

  Right side of building

Wall Interior

• Wall Interior Deficiencies

  Select Interior wall has a loose or detached surface covering. Interior wall component(s) is not functionally adequate. Interior wall has a hole that is greater than 2 inches in diameter or there is an accumulation of holes that are cumulatively greater than 6 inches by 6 inches. N/A

  • Interior wall has a loose or detached surface covering.
  • Interior wall component(s) is not functionally adequate.
  • Interior wall has a hole that is greater than 2 inches in diameter or there is an accumulation of holes that are cumulatively greater than 6 inches by 6 inches.
  • N/A

• Location

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)

Water Heater

• Water Heater Deficiencies

  Select Temperature pressure relief (TPR) valve has an active leak or is obstructed or relief valve discharge piping is damaged, capped, has an upward slope, or is constructed of unsuitable material. No hot water. The relief valve discharge piping is missing or terminates greater than 6 inches or less than 2 inches from waste receptor flood-level. Chimney or flue piping is blocked, misaligned, or missing. Gas shutoff valve is damaged, missing, or not installed. N/A

  • Temperature pressure relief (TPR) valve has an active leak or is obstructed or relief valve discharge piping is damaged, capped, has an upward slope, or is constructed of unsuitable material.
  • No hot water.
  • The relief valve discharge piping is missing or terminates greater than 6 inches or less than 2 inches from waste receptor flood-level.
  • Chimney or flue piping is blocked, misaligned, or missing.
  • Gas shutoff valve is damaged, missing, or not installed.
  • N/A

Window

• Window Deficiency

  Select Window will not open or stay open. Window cannot be secured. Window will not close. Window component is damaged or missing and the window is not functionally adequate. N/A

  • Window will not open or stay open.
  • Window cannot be secured.
  • Window will not close.
  • Window component is damaged or missing and the window is not functionally adequate.
  • N/A

• Location?

  Select Throughout Unit Foyer Kitchen Dining Room Living room Hallway Bathroom 1 Bathroom 2 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Basement Storage Unit Mechanical Room Common Bathroom - Men Common Bathroom - Woman Common Hallway or Stairwell Laundry Center Learning Center Outdoors, (add location to notes)

  • Throughout Unit
  • Foyer
  • Kitchen
  • Dining Room
  • Living room
  • Hallway
  • Bathroom 1
  • Bathroom 2
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Basement
  • Storage Unit
  • Mechanical Room
  • Common Bathroom - Men
  • Common Bathroom - Woman
  • Common Hallway or Stairwell
  • Laundry Center
  • Learning Center
  • Outdoors, (add location to notes)