Title Page
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Address of Property
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Date of Interview
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Officers Name
- Daniel Jones
- Tracey Reed
- Matt Wicks
- Yvonne Haward
- Heidi Foster
- Samantha Phillips
- Debbie Gregory
- Dan Kingham
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Photo ID
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2. Tenants Name/s
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Other members of household
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3. Telephone Number
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4. Email Address
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5. Proof of Identity produced
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Officer Satisfied
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Further action taken
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Communication preference
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Do they have any communication requirements? i.e large print for vision impairments
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Please specify
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Are they available during the working week?
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When are they not available?
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Do they have any health/medical needs where this may impact the housing situation that we do not know about?
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Please specify
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Do they have any Disability under the equality act 2010? (Any long term physical/mental impairment which has substantial adverse affects on day to day activities)
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Please specify
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Does anyone in the household have a special housing need because of any of the following:
- Permanent physical disability
- Learning disability
- Visual impairment
- Hearing impairment
- Experiencing domestic abuse
- Mental health problems
- Young person leaving care
- Ex-offender
- Isolated- no support
- English is not my first language
- Issue with alcohol misuse
- Issue with drug misuse
- Issue with literacy
- May need help bidding with no one to help
- Experiencing anti-social behaviour/harassment
- Age-related mental infirmity i.e Alzheimers/Dementia
- Age-related physical infirmity i.e Arthritis/Unsteadfastness
- Long term mental health condition
- Long term physical health condition
- None
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Please specify who and the housing need.
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Any mental health issues and diagnosis?
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Please specify
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Are they working with any support workers/services?
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Please specify
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Do they have any pets?
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Please specify
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Communal landing area clear of household items?
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Are fittings/fixtures we provide in good condition?
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Is there any damp or mould in the household?
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Is the home in a clean and tidy manner and decorated as necessary?
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Is the garden maintained?
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Any alterations carried out including occupational adaptations?
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Please specify. Also has permission been sought?
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Any repairs required?
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Please specify
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Ensure they have housing repairs phone number: 01255 686477
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Advise tenants if they are on Universal credit about 'Social Tariffs' that could help them with paying water bills/phones/broadbands
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Do they know their tenant manager for the area?
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Tenants Signature
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Officers Signature
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Date
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What action has been taken from this visit?
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Would they like more frequent visits/opportunity to touch base?
