Title Page
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Property Address1
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Date Completed
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Inspected by
Description of visit
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Please explain the purpose of you inspection:
Repairs Summary
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Kitchen
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Bathroom
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WC
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Hallway
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Lounge
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Bedroom 1
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Bedroom 2
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Bedroom 3
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Front External
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Back External
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other
HHSRS Health and Safety Hazards
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Damp and mould growth
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Excess cold
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Excess heat
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Asbestos and MMF
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Biocides
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Carbon monoxide and fuel combustion products
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Lead
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Radiation
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Uncombusted fuel gas
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Volatile organic compounds
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Crowding and space
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Entry by intruders
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Lighting
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Noise
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Domestic hygiene, pests and refuse
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Food safety
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Personal hygiene, sanitation and drainage
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Water supply
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Falls associated with baths etc.
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Falling on level surfaces etc.
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Falling on stairs etc.
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Falling between levels
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Electrical hazards
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Fire
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Flames, hot surfaces etc.
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Collision and entrapment
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Explosions
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Position and operability of amenities etc.
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Structural collapse and falling elements
Summary of visit
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Please outline the results of your visit and action to be taken:
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If related to damp and mould please confirm cause here:
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Is the property safe and habitable for the residents to remain at home?
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Please ensure a property loss form has been completed and a part A form has been sent to decants.
