RD Template

• Conducted on

  Date

• Prepared by

• Location
  Address

• Do you rent from Council, Housing Association or Private Landlord?

  Council

  Housing Association

  Private

• Can you confirm the approximate date you moved in?

• When did you first report the current issues?

• When did you most recently report the current issues?

• How were the issues reported?

  Phone

  Email

  Online

  Office

  Other

• How many times have you reported the issues?

• Is this a single or joint tenancy?

  Single

  Joint

• Please provide details of Joint Applicant

• What is the rental amount?

• What type of tenancy is this?

  Temporary

  Permanent

• Are you in any rental arrears?

  Yes

  No

  N/A

• If so, how much?

• Have you arranged a payment plan?

  Yes

  No

  N/A

• At what rate are you repaying the arrears?

• Are you due to move from the property?

  Yes

  No

  N/A

• Has a date been set to repair the property?

  Yes

  No

  N/A

• When?

• Do you have any special requirements that we should be made aware of?

  Yes

  No

  N/A

• Please provide information

• Do you currently or have you ever had solicitors acting for you?

  Yes

  No

  N/A

• Summary of Disrepair

Client Details

• Title

• First Name

• Middle Name/s (if applicable)

• Surname

• Clients Full Address including Postcode

• Contact Number

• Alternative Contact Number

• Email Address

• National Insurance Number

• Occupation

• Nationality

• First Language

• Client Representative Required?

  Yes

  No

  N/A

• If yes, provide details

• Password

Client Details 2

• Title

• First Name

• Middle Name/s (if applicable)

• Surname

• Clients Full Address including Postcode

• Contact Number

• Alternative Contact Number

• Email Address

• National Insurance Number

• Occupation

• Nationality

• First Language

• Client Representative Required?

  Yes

  No

  N/A

• If yes, provide details

• Password

Defendant

• Name of defendant

About the Tenancy

• Type of Property

• If its a flat, what floor does the client live on?

• No. Of Occupants

Disrepair

• What is your opinion on the cause of the defects?

• Number of rooms affected

• Did the landlord respond?

  Yes

  No

  N/A

• If yes, what was their response?

• Do you have any correspondence relating to their response?

  Yes

  No

  N/A

• What repairs were carried out, if any?

• Do you have any evidence of reporting? (Emails, texts or portal reports?

  Yes

  No

  N/A

• When was the most recent annual gas check?

• When was the most recent annual electricity check?

• Has a formal complaint been made?

  Yes

  No

  N/A

• Have you reported to your local MP?

  Yes

  No

  N/A

• Have the issues been reported to Environmental Health?

  Yes

  No

  N/A

• Have the issues been reported to the Housing Ombudsman Service?

  Yes

  No

  N/A

• Are there any emergency repairs?

  Yes

  No

  N/A

• If so, what are they?

Room by Room

• Room 1

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 2

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 3

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 4

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 5

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 6

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 7

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 8

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 9

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Room by Room

• Room 10

  Select Living Room Dining Room Kitchen Conservatory Hallway Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom WC Attic Roof Guttering Front Garden Rear Garden Other Externals Porch Pantry

  • Living Room
  • Dining Room
  • Kitchen
  • Conservatory
  • Hallway
  • Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • WC
  • Attic
  • Roof
  • Guttering
  • Front Garden
  • Rear Garden
  • Other Externals
  • Porch
  • Pantry

• Details of Disrepair

• First Report

• Last Report

• No. of times reported

• Reporting method

• Are all windows, vents and fans fully operational?

Lifestyle/Use of Property

• How are the issues affecting your daily life?

• Are you embarrassed to have visitors?

  Yes

  No

  N/A

• Do any of the tenants smoke?

  Yes

  No

  N/A

• If so, who?

• Have you carried out any DIY or plumbing work to the property?

  Yes

  No

  N/A

• If so, what?

• Anything further to note that may affect claim (method of bathing due to beliefs, etc)

Personal Injury

• Have you sustained injury or illness?

  Yes

  No

  N/A

• If yes, please provide further information on how and when?

Witnesses

• Name

• Date of Birth

• Contact Number

Witnesses

• Name

• Date of Birth

• Contact Number

Witnesses

• Name

• Date of Birth

• Contact Number

Financial Losses

• Item

• Cost £

• Damage

• Evidence?

  Yes

  No

  N/A

Financial Losses

• Item

• Cost £

• Damage

• Evidence?

  Yes

  No

  N/A

Financial Losses

• Item

• Cost £

• Damage

• Evidence?

  Yes

  No

  N/A

Financial Losses

• Item

• Cost £

• Damage

• Evidence?

  Yes

  No

  N/A

Financial Losses

• Item

• Cost £

• Damage

• Evidence?

  Yes

  No

  N/A

Infestation

• Do you have any infestation in your property?

  Yes

  No

  N/A

• When was it first noticed?

• What exactly was noticed?

• Was it reported?

  Yes

  No

  N/A

• If so, when was it reported?

• Who was it reported too?

• How many times has it been reported?

• Do you have any evidence of complaints?

  Yes

  No

  N/A

• Any attempts by the landlord to deal with this?

  Yes

  No

  N/A

• Has a report been prepared by the landlord?

  Yes

  No

  N/A

• Do you have a copy?

  Yes

  No

  N/A

• Is perishable food ever left on worktops?

  Yes

  No

  N/A

• Are dishes washed on a daily basis?

  Yes

  No

  N/A

• Is the client considered to be a hoarder?

  Yes

  No

  N/A

• Is the home in a reasonably clean condition?

  Yes

  No

  N/A

• Does the indoor bin have a secure lid?

  Yes

  No

  N/A

• Is rubbish regularly taken out?

  Yes

  No

  N/A

• Is there any stagnant water outside or near the property?

  Yes

  No

  N/A

• Is there decking in the garden?

  Yes

  No

  N/A

• If yes, was decking present when moving in?

  Yes

  No

  N/A

• Any renovations that could potentially allow infestation to occur?

  Yes

  No

  N/A

• Please provide any evidence of disrepair

  Media

Evidence of Reporting

• Please provide any evidence of reporting (emails, portal receipts)

  Media

Evidence of Personal Injury

• Please provide evidence of any personal injuries due to the disrepair

  Media

Evidence of Financial Loss

• Please provide evidence of any financial losses (receipts of good, photographic damage)

  Media

Evidence of Infestation

• Please provide evidence of any infestation

  Media