• Address

  • Location
  • Unit ID

  • Inspector

  • Incident Number

  • Call Date

  • Time Call Received

  • Arrival Time

  • Time Back In Service

  • Call Received From

  • Additional City Personnel/Agencies on Site

  • Nature of the Call

Call Findings & Results

  • Owner/Agent Name

  • OwnerAgent Street Address

  • OwnerAgent City, State & Zip

  • Owner/Agent Phone

  • Tenant Name

  • Tenant Phone

  • Comments/Violations

  • Photos

  • Were the premises made UNSAFE/UNFIT?

  • How many occupants/tenants were dislocated from the building/unit?

  • Did the occupant(s)/tenants have a place to go?

  • Did you provide relocation slip(s)?

  • Was the building secured with a city padlock?

  • Actions Taken

  • Has this information been entered into Department Computer System?

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.