Title Page
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Conducted on
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Prepared by
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Location
Basic Info
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Full Name
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Address & Postcode
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Are you a housing association/council tenant?
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Is your tenancy agreement permanent?
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Is it a single or joint tenancy agreement?
- Single
- Joint
VP Questions
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Have you ever made a claim for Housing Disrepair before?
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Are you planning on moving out in the next 12 months?
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6. Do you have any rent arrears?
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How much rent arrears?
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Do you have anyone legally representing you when it comes to your housing disrepair issues?
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How long have you been living with the disrepair issues?
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Have you previously reported these issues to your landlord or property management?
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If yes, when was the most recent report/compaint, you made to yur landlord?
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11. Have any attempts been made to fix the issues by your landlord?
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What was the oucome?
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Do you have any documentation or communication records about the issues and your correspondence with the landlord?"
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Are there any immediate health or safety concerns associated with the disrepair that you are worried about?"
Descriptive
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Room 1
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Room 2
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Room 3
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Room 4
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Room 5
