PSG Shared Room

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Entry/Living Area

• Entrance

  Yes

  No

  N/A

• Screen Door/Security Door in good condition? (If no, does it need cleaning, repair or replace?)

  Yes

  No

  N/A

• Entry door in good condition?

  Yes

  No

  N/A

• Windows slide easily and lock?

  Yes

  No

  N/A

• Window screens are in place and in good conditions? (if no, is it missing, torn, or bent)

  Yes

  No

  N/A

• Area ceiling in good conditions? (if no, patching: is it texture, smooth, or popcorn)

  Yes

  No

  N/A

• Curtain in good conditions?

  Yes

  No

  N/A

• Flooring in good condition? (if no, tile cracked, vinyl bad, carpet)

  Yes

  No

  N/A

• AC in working conditions

  Yes

  No

  N/A

• Light fixture

  Yes

  No

  N/A

• Smoke detector in working condition? (Hardwire or Battery)

  Yes

  No

  N/A

• All wall outlets in area have cover plates in working conditions & matching?

  Yes

  No

  N/A

• TV and TV Remote

  Yes

  No

  N/A

Kitchenette Area

• Door in good conditions?

  Yes

  No

  N/A

• Kitchenette cabinet door

  Yes

  No

  N/A

• Window screens are in place and in good conditions? (if no, is it missing, torn, or bent)

  Yes

  No

  N/A

• Area walls are clean?

  Yes

  No

  N/A

• Area ceiling in good conditions? (if no, patching: is it texture, smooth, or popcorn)

  Yes

  No

  N/A

• Drapes/Blinds in good conditions? (if no, missing slats, how many? Or broken track)

  Yes

  No

  N/A

• Flooring in good condition?

  Yes

  No

  N/A

• Light fixture/Ceiling fan in good condition?

  Yes

  No

  N/A

• Smoke detector in working condition? (Hardwire or Battery)

  Yes

  No

  N/A

• All wall outlets in area have cover plates?

  Yes

  No

  N/A

Kitchen Area

• Door in good conditions?

  Yes

  No

  N/A

• Windows slide easily and lock?

  Yes

  No

  N/A

• Window screens are in place and in good conditions? (if no, is it missing, torn, or bent)

  Yes

  No

  N/A

• Area walls are clean?

  Yes

  No

  N/A

• Area ceiling in good conditions?

  Yes

  No

  N/A

• Drapes/Blinds in good conditions?

  Yes

  No

  N/A

• Flooring in good condition? (Tile cracked or loose, if vinyl is it in poor conditions)

  Yes

  No

  N/A

• Light fixture/Ceiling fan in good condition?

  Yes

  No

  N/A

• All wall outlets in area have cover plates?

  Yes

  No

  N/A

• Are cabinets clean and in good conditions inside and out? (if no, latches missing,? Etc?)

  Yes

  No

  N/A

• Counter tops in good conditions?

  Yes

  No

  N/A

• Sink and Faucet appear in good conditions without leaks when turned on?

  Yes

  No

  N/A

• Does the sink require caulking around the areas?

  Yes

  No

  N/A

• Hot Water/Cold Water run properly when turned on?

  Yes

  No

  N/A

• Are there any leaks under the sink when water in running?

  Yes

  No

  N/A

• Is the garbage disposal in working conditions when turned on and free of leaks?

  Yes

  No

  N/A

• Was dishwasher tested, in good working conditions and free of leaks?

  Yes

  No

  N/A

• Is refrigerator in good and operable conditions?

  Yes

  No

  N/A

• Is microwave in good working conditions?

  Yes

  No

  N/A

• Is stove & oven clean and in working conditions?

  Yes

  No

  N/A

• Is stove vent in clean and working conditions?

  Yes

  No

  N/A

Master Bedroom

• Door in good conditions?

  Yes

  No

  N/A

• Windows slide easily and lock?

  Yes

  No

  N/A

• Window screens are in place and in good conditions?

  Yes

  No

  N/A

• Area walls are clean?

  Yes

  No

  N/A

• Area ceiling in good conditions?

  Yes

  No

  N/A

• Drapes/Blinds in good conditions?

  Yes

  No

  N/A

• Flooring in good condition?

  Yes

  No

  N/A

• Light fixture/Ceiling fan in good condition?

  Yes

  No

  N/A

• Smoke detector in working condition?

  Yes

  No

  N/A

• All wall outlets in area have cover plates?

  Yes

  No

  N/A

Master Bathroom

• Door in good conditions?

  Yes

  No

  N/A

• Windows slide easily and lock?

  Yes

  No

  N/A

• Window screens are in place and in good conditions?

  Yes

  No

  N/A

• Area walls are clean?

  Yes

  No

  N/A

• Area ceiling in good conditions?

  Yes

  No

  N/A

• Drapes/Blinds in good conditions?

  Yes

  No

  N/A

• Flooring in good condition?

  Yes

  No

  N/A

• Light fixture in good condition?

  Yes

  No

  N/A

• Exhaust fan in good and operable conditions?

  Yes

  No

  N/A

• Is Heat Lamp/Heater in working condition?

  Yes

  No

  N/A

• Sink and Faucet appear in good conditions without leaks when turned on?

  Yes

  No

  N/A

• Does the sink require caulking around the areas?

  Yes

  No

  N/A

• Hot Water/Cold Water run properly when sink is turned on?

  Yes

  No

  N/A

• Are there any leaks under the sink when water in running?

  Yes

  No

  N/A

• Is tub and faucet in good working condition?

  Yes

  No

  N/A

• Does tub require caulking around the areas?

  Yes

  No

  N/A

• Does the tub require reglazing if unable to clean?

  Yes

  No

  N/A

• Does the tub faucet leak when in off position?

  Yes

  No

  N/A

• Is the shower in good conditions without leaks when in off position?

  Yes

  No

  N/A

• Are shower and faucet on and off knobb(s) in good working conditions?

  Yes

  No

  N/A

• Are shower walls in clean and presentable conditions?

  Yes

  No

  N/A

• Are shower doors in clean and operable conditions?

  Yes

  No

  N/A

• Is the toilet in good conditions?

  Yes

  No

  N/A

• Does the toilet rock, leak or has water running constantly?

  Yes

  No

  N/A

• Are cabinets, countertops & mirror in good conditions?

  Yes

  No

  N/A

• Towel bars & tissue roll bar in good conditions?

  Yes

  No

  N/A

• Are there any safety bars (grab bars) in bathroom? If yes, are they in a safe and good condition?

  Yes

  No

  N/A

• GFI Outlet has cover plate and is working properly?

  Yes

  No

  N/A

• Are there any signs on mold, mildew or water damage on walls?

  Yes

  No

  N/A

Bedroom 2

• Door in good conditions?

  Yes

  No

  N/A

• Windows slide easily and lock?

  Yes

  No

  N/A

• Window screens are in place and in good conditions?

  Yes

  No

  N/A

• Area walls are clean?

  Yes

  No

  N/A

• Area ceiling in good conditions?

  Yes

  No

  N/A

• Drapes/Blinds in good conditions?

  Yes

  No

  N/A

• Flooring in good condition?

  Yes

  No

  N/A

• Light fixture/Ceiling fan in good condition?

  Yes

  No

  N/A

• Smoke detector in working condition?

  Yes

  No

  N/A

• All wall outlets in area have cover plates?

  Yes

  No

  N/A

General

• Date unit became vacant?

  Date

• Is unit in need of Cleaning crew?<br>

  Yes

  No

  N/A

• Does the overall condition of the unit consider the unit a "REHAB" unit?

  Yes

  No

  N/A

• Does the overall condition of the walls require a new coat of paint?

  Yes

  No

  N/A

• Was the resident present during the inspection?

  Yes

  No

  N/A

• Were utilities on during the inspection?

  Yes

  No

  N/A

Comments

• Additional Comments:

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• On Site Representative / Resident

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• On Site Inspector

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