VR0026 - Housing Inspection and Maintenance Plan

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Expire Date

  Date

• Total number of houses on site

• Number of houses with legal occupants not working on farm (ESTA)

• Number of houses with illegal occupants

• Explanation of illegal occupancy

House

• Unit Number

• Name of Occupant

• Number of Occupants - Working on this farm

• Number of Occupants - Not working on farm

• General Neatness / Hygiene conditions

  Good

  Fair

  Poor

  N/A

• Sand bucket available

  Compliant

  Non-Compliant

  N/A

• No Marijuana grown in garden

  Compliant

  Non-Compliant

  N/A

• Pets kept on property

  Yes

  No

  N/A

• How many cats

• How many dogs

Roof

• Asbestos Free

  Yes

  No

  N/A

• Ceiling availability

  Yes

  No

  N/A

• Asbestos in good condition

  Yes

  No

  N/A

• Asbestos sign available

  Yes

  No

  N/A

• Skirtings and ceiling bord in good condition

  Compliant

  Non-Compliant

  N/A

• Roof not leaking

  Compliant

  Non-Compliant

  N/A

• Date of planned maintenance

  Date

Walls

• Walls - Painted - Not peeling

  Compliant

  Non-Compliant

  N/A

• Date of planned maintenance

  Date

• Walls - Free of black mold

  Compliant

  Non-Compliant

  N/A

• Walls - Damp Free

  Compliant

  Non-Compliant

  N/A

• Walls - No Cracks

  Compliant

  Non-Compliant

  N/A

• Walls - Higiene

  Compliant

  Non-Compliant

  N/A

Front Porch

• Porch in good condition

  Compliant

  Non-Compliant

  N/A

Front Door

• Weather Proof

  Compliant

  Non-Compliant

  N/A

• Can Lock

  Compliant

  Non-Compliant

  N/A

• Door knobs available

  Compliant

  Non-Compliant

  N/A

• Door hinges working

  Compliant

  Non-Compliant

  N/A

• Door handle available

  Compliant

  Non-Compliant

  N/A

Electricity

• Electricity box in good condition

  Compliant

  Non-Compliant

  N/A

• Electric sign on power box

  Compliant

  Non-Compliant

  N/A

• No overloading of electricity

  Compliant

  Non-Compliant

  N/A

• Plugs in working condition

  Compliant

  Non-Compliant

  N/A

• Light fittings

  Compliant

  Non-Compliant

  N/A

Windows

• Window in good condition (not broken, cracked or missing)

  Compliant

  Non-Compliant

  N/A

• Window - Latch in good condition (not broken or missing)

  Compliant

  Non-Compliant

  N/A

• Window - Arms in good condition (not broken or missing)

  Compliant

  Non-Compliant

  N/A

• Window - fitted (no putty loose or missing)

  Compliant

  Non-Compliant

  N/A

Floors

• Floor - Even

  Compliant

  Non-Compliant

  N/A

• Planned maintenance date

  Date

Kitchen

• Separate from sleeping are

  Yes

  No

  N/A

• Kitchen sink is not leaking

  Compliant

  Non-Compliant

  N/A

• Kitchen tap - Water available

  Compliant

  Non-Compliant

  N/A

• Kitchen tap - Not leaking

  Compliant

  Non-Compliant

  N/A

• Cabinet in good condition

  Compliant

  Non-Compliant

  N/A

Bathroom

• Toilet door can close for privacy

  Compliant

  Non-Compliant

  N/A

• Geyser working

  Compliant

  Non-Compliant

  N/A

• Shower head is in working condition

  Compliant

  Non-Compliant

  N/A

• Shower tap has water

  Compliant

  Non-Compliant

  N/A

• Shower higinic

  Compliant

  Non-Compliant

  N/A

• Toilet lid available and in good repair

  Compliant

  Non-Compliant

  N/A

• Toilet not leaking

  Compliant

  Non-Compliant

  N/A

• Toilet flash working

  Compliant

  Non-Compliant

  N/A

• Toilet has got water to flash

  Compliant

  Non-Compliant

  N/A

• Toilet bowl in good condition

  Compliant

  Non-Compliant

  N/A

• Sink is good condition

  Compliant

  Non-Compliant

  N/A

• Sink taps not leaking

  Compliant

  Non-Compliant

  N/A

• Sink taps has water

  Compliant

  Non-Compliant

  N/A
Bedrooms

• Window not cracked or missing

  Compliant

  Non-Compliant

  N/A

• Door in good condition

  Compliant

  Non-Compliant

  N/A

• Signed by occupant as proof of inspection

  Sign

• Other comments