Title Page
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Site conducted
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Conducted on
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Prepared by
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Total number of houses on site
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Number of houses with legal occupants not working on farm (ESTA)
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Number of houses with illegal occupants
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Explanation of illegal occupancy
Housing Inspection
- House
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Unit Number
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Name of Occupant
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Number of Occupants - Working on this farm
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Number of Occupants - Not working on farm
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General Neatness / Hygiene conditions
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Sand bucket available
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No Marijuana grown in garden
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Pets kept on property
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How many cats
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How many dogs
Roof
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Asbestos Free
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Ceiling availability
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Asbestos in good condition
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Asbestos sign available
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Skirtings and ceiling bord in good condition
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Roof not leaking
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Date of planned maintenance
Walls
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Walls - Painted - Not peeling
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Date of planned maintenance
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Walls - Free of black mold
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Walls - Damp Free
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Walls - No Cracks
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Walls - Higiene
Front Porch
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Porch in good condition
Front Door
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Weather Proof
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Can Lock
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Door knobs available
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Door hinges working
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Door handle available
Electricity
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Electricity box in good condition
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Electric sign on power box
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No overloading of electricity
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Plugs in working condition
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Light fittings
Windows
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Window in good condition (not broken, cracked or missing)
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Window - Latch in good condition (not broken or missing)
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Window - Arms in good condition (not broken or missing)
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Window - fitted (no putty loose or missing)
Floors
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Floor - Even
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Planned maintenance date
Kitchen
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Separate from sleeping are
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Kitchen sink is not leaking
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Kitchen tap - Water available
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Kitchen tap - Not leaking
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Cabinet in good condition
Bathroom
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Toilet door can close for privacy
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Geyser working
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Shower head is in working condition
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Shower tap has water
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Shower higinic
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Toilet lid available and in good repair
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Toilet not leaking
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Toilet flash working
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Toilet has got water to flash
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Toilet bowl in good condition
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Sink is good condition
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Sink taps not leaking
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Sink taps has water
Bedrooms
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Window not cracked or missing
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Door in good condition
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Signed by occupant as proof of inspection
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Other comments