test DMC Inspection Report

• Inspection date

  Date

• Resident name

• Address
  Address

• Email address

• Mobile number

• Are you the Tenant?

  Yes

  No

• Name

• Relationship to Tenant

The people in the home

• How many occupants are there in the property?

  Select One Two Family of 3 Family of 4 Family of 5 Family of 6 More than 6

  • One
  • Two
  • Family of 3
  • Family of 4
  • Family of 5
  • Family of 6
  • More than 6

• How long have you lived here?

• Is anyone in your home considered to be vulnerable because of their health of other issues?

  Yes

  No

• What vulnerabilities?

About the problems in your home

• Briefly, what is the problem in your home?

• When did you first notice this problem?

• When did you first report it?

• Have there been recent repairs?

  No

  Yes

• What repairs and when?

• Did this solve the problem?

  Yes

  No

• What still needs to be done (previous repairs)

• Have you made any repairs?

  Yes

  No

• What repairs have you done?

Damp

• Is there damp or mould in the property?

  Yes

  No

• In what rooms are clothes dried?

• Are you able to keep the house warm when it is cold?

  Yes

  No

  Sometimes

• Have you moved any loft insulation during your occupation of the premises

  Yes

  No

• Are there any pipes leaking

  Yes

  No

• Are there any tiles missing from the roof?

  Yes

  No

• Are there any gutters leaking?

  Yes

  No

• Are there any other defects leading to damp?

  Yes

  No

The building

• Type of property

  Select Semi-detached bungalow Detached bungalow End of terrace Mid terrace Semi-detached house Detached house Townhouse Maisonette Flat (basement) Flat (ground floor) Top floor flat Flat (other)

  • Semi-detached bungalow
  • Detached bungalow
  • End of terrace
  • Mid terrace
  • Semi-detached house
  • Detached house
  • Townhouse
  • Maisonette
  • Flat (basement)
  • Flat (ground floor)
  • Top floor flat
  • Flat (other)

• What floor are you on?

• How many bedrooms?

  Select 1 2 3 4 5 6 or more

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6 or more

• How many bathrooms / toilets?

  1

  2

  3

  4 or more

• Known insulation

  Select Loft Cavity wall insulation External wall insulation Internal wall insulation Uncertain Not known

  • Loft
  • Cavity wall insulation
  • External wall insulation
  • Internal wall insulation
  • Uncertain
  • Not known

• What type of glazing does the property have?

  Select Double UPVC with Trickle Vents Double UPVC NO Vents Single glazing Aluminum Double with Trickle Vents Aluminum Double NO Vents

  • Double UPVC with Trickle Vents
  • Double UPVC NO Vents
  • Single glazing
  • Aluminum Double with Trickle Vents
  • Aluminum Double NO Vents

Room detail

Affected areas

• Living Room

• Images of Living Room

  Media

• What damage / disrepair is evidenced in the above photos?

• What repairs need to be done?

• Photos of defects

  Media

• Kitchen

• Images

  Media

• Is there an extractor fan in your kitchen?

  Yes

  No

• Does it work?

  Yes

  No

• Photo of extractor fan

  Media

• What damage / disrepair is evidenced in the above photos?

• What repairs need to be done?

• Photos of defects

  Media

• Bathroom

• Images

  Media

• Is there an extractor fan in your main (or affected) bathroom / shower room?

  Yes

  No

• Does it work?

  Yes

  No

• Photo of extractor fan

  Media

• What damage / disrepair is evidenced in the above photos?

• What repairs need to be done?

• Photos of defects

  Media

• Hallway

• Images of Hallway

  Media

• What damage / disrepair is evidenced in the above photos?

• What repairs need to be done?

• Photos of defects

  Media

• Bedrooms

Bedroom

• Images

  Media

• What damage / disrepair is evidenced in these photographs

• What repairs need to be done?

• Photos of defects

  Media

• Additional areas

• Images

  Media

• What damage / disrepair is evidenced in the above photos?

• What repairs need to be done?

• Photos of defects

  Media

The impact on you and your family

• Has any damage been caused to personal property by the issues complained of? (For example clothing, linen, soft furnishings)

  Yes

  No

• Please list items damaged (and add photos)

• Have the issues complained about affected your, or other occupants permanently residing at the property, physical or mental health?

  Yes

  No

• Please provide detail of who and the problems suffered?

The heating system in your home

• What type of room heating is in the property?

  Select Gas central heating with radiators throughout Gas central heating with radiators in ground floor only Gas central heating with radiators in upstairs rooms only Oil storage heaters to ground floor only Oil storage heaters to upstairs rooms only Electric storage heaters Open coal fire Underfloor heating Warm air/heat pumps Combination of styles Not sure

  • Gas central heating with radiators throughout
  • Gas central heating with radiators in ground floor only
  • Gas central heating with radiators in upstairs rooms only
  • Oil storage heaters to ground floor only
  • Oil storage heaters to upstairs rooms only
  • Electric storage heaters
  • Open coal fire
  • Underfloor heating
  • Warm air/heat pumps
  • Combination of styles
  • Not sure

• Is there a boiler?

  Yes

  No

• Is there a Gas Fire?

  Yes

  No

• Is the heating system and all the components in full working order?

  Yes

  No

• Is the heating system used to heat the property effectively?

  Yes

  No

• What barriers are there to heating the property effectively?

• Is an ECOE referral required

  Yes

  No

• Is Housing Management support required?

  Yes

  No