Title Page

  • Site Visit?

  • Reference:

  • Client Name:

  • Client Home phone/Mobile

  • Client e-mail:

  • Client date of birth:

  • Client occupation:

  • PROPERTY & TENANCY ASSESSMENT

  • Address of property:

  • Type of property:

  • If flat / Tower block which floor do you live on:

  • Status in property: SINGLE/JOINT

  • Type of tenancy Agreement:

  • Monthly/weekly rent:

  • Any rent arrears and amount:

  • Have arrears resulted in any court action:

  • Date tenancy agreement started:

  • Do you have a copy of your tenancy agreement:

  • Name and address of landlord / council / housing association:

  • How many downstairs rooms are there in the property if applicable

  • How many bedrooms are in the property:

  • LIST OF DEFECTS & OTHER INFO

  • Room Name

  • Room Name

  • Room Name

  • Room Name

  • Room Name

  • Room Name

  • Room Name

  • Gas Safety

  • External

  • When did you notice the defect / disrepair:

  • Has the landlord been informed of the dis-repair:

  • If so, how and when:

  • How many times have you contacted the landlord about the disrepair in total:

  • Do you have any evidence of the notice (copy letters / emails):

  • Has your landlord inspected your property following notification of the defect:

  • If so, when and what action was taken:

  • Have you ever reported the defects to your local councils Environmental Health Department

  • If yes, what action did they take?

  • What heating installations do you have in the property:

  • Is it working:

  • If not working, what is wrong:

  • Do you use the heating:

  • If not, why:

  • FIXTURES & FITTINGS

  • Do all baths, toilets and sinks work in the property:

  • If no - details

  • PERSONAL INJURY / HEALTH ISSUES

  • PERSONAL EFFECTS - DAMAGE

  • Have any personal effects been damaged by the disrepair:

  • ID/Proof of Address (dated within last 4 months)

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.