Information
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Conducted on
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Prepared by
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Address
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Tenant(s) Full Name(s) and DOB(s)
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Ethnic Origin
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Religion
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Nationality
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Language
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Gender
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Sexual Orientation
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Email Address
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Telephone Number
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Name, DOB & Relationship to tenant of all household members
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Does any member of the household have a disability? If yes, give details.
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Are the any needs within the household that require an individual service? If so, what is needed?
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Proof of Identity Seen
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Proof of Residency Seen
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Overall impression of the property (internal)
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Overall impression of the property (external)
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Does the property look occupied?
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Did you notice anything suspicious?
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Is the customer aware of any unauthorised occupants?
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Details of any items of concern for follow up
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Rent - is the customer experiencing any difficulties? If so make notes and refer to ICC
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Issue reminder to tenant re the importance of allowing access for gas servicing and of reporting any repairs immediately to the CSC.
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Are there any outstanding repairs? If yes, direct to CSC 0845 850 9571
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Are any aids or adaptations required?
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If yes, give details:
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Is the tenant interested in becoming involved in helping us to deliver a better service?
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If yes, give details:
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Is the customer looking to move properties?
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If yes, give details (e.g. Reason for move, type of property needed)
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Neighbourhood Officer Notes/Comments
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Customer Signature
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Officer Signature
