Department of Housing and Urban Development Inspection Form 52580

8/9/2019 Department of Housing and Urban Development Inspection Form 52580

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Inspection Form U.S. Department of Housing OMB Approval No. 2577-016

and Urban Development (exp. 09 /30/ 2Housing Choice Voucher Program Office of Public and Indian Housing

Public reporting burden for this collection o f information i s estimated to a ve rage 0. 25 hours per r esponse, i n cluding t h e time f o r reviewing instructions,searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may notconduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.

Privacy Act Statement . The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by Section 8 ofthe U.S. Housing Act of 1937 (42 U.S.C. 1437f). Collection of the name and address of both the family and the owner is mandatory. The information is used todetermine if a unit meets the housing quality standards of the section 8 rental assistance program. HUD may disclose this information to Federal, State and local

agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except aspermitted or required by law. Failure to provide any of the information may result in delay or rejection of family participation.

Assurances of confidentiality are not provided under this collection. This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to determine if a unit meets the housing quality standards of the section 8 rental assistance program. PHA Tenant ID Number Date of Request (mm/dd/yyyy)

Inspector Date Last Inspection (mm/dd/yyyy) Date of Inspection (mm/dd/yyyy)

Type of Inspection Project Number Neighborhood/Census Tract

Initial Special Reinspection A. General Information Street Address of Inspected Unit

City County State Zip

Name of Family Current Telephone of Family

Current Street Address of Family

City County State Zip

Number of Children in Family Under 6

Name of Owner or Agent Authorized to Lease Unit Inspected Telephone of Owner or Agent

Address of Owner or Agent

Housing Type (check as appropriate)Single Family Detached Duplex or Two Family Row

House or Town House Low Rise: 3,4 Stories, IncludingGarden Apartment High Rise; 5 or More Stories

Manufactured Home

Congregate Cooperative Independent Group Residence

Single Room OccupancyShared Housing

Other:(Specify)

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B. Summary Decision on the Unit (to be completed after the form has been filled in) Housing Quality Standard Pass or Fail

1. Fail If there are any checks under the column headed Fail the unit fails the minimum housing quality standards. Discuss with the owner therepairs noted that would be necessary to bring the unit up to the standard.

2. Inconclusive If there are no checks under the column headedFail

and t h ere ar e ch ecks under the c o lumn headed Inconclusive, obt a inadditional information necessary for a decision (question owner or tenant as

indicated in t he item i nstructions given in this c hecklist) . O nce additionalinformation is obtained, change the rating for the item and record the date ofverification at the far right of the form.

3. Pass If ne ither ( 1) nor ( 2) above is checked, t h e u n it pa sses theminimum housing quality standards. Any additional conditions described in theright hand column of the form should serve to (a) establish the precondition of theunit, (b) indicate possible additional areas to negotiate with the owner, (c) aid in as s essing the r easonableness of the rent of the uni t, and ( d) aidthe tenant in deciding among possible units to be rented. The tenant isresponsible for dec iding w h ether he or s h e f inds t h ese c onditionsacceptable.

Unit Size: Count the number of bedrooms for purposes of the

FMR or Payment Standard. Record in the box provided.

Year Constructed: Enter from Line 5 of the

Request for Tenancy Approval form. Record in the box provided.

Number of Sleeping Rooms : Count the number of rooms which could be used for sleeping, as identified on the checklist. Record in the boxprovided.C. How to Fill Out This Checklist Complete the checklist on the unit to be occupied (or currently occupied) bythe tenant. Proceed through the inspection as follows: Area Checklist Category room by room 1. Living Room

2. Kitchen 3. Bathroom 4. All Other Rooms Used for Living 5. All Secondary Rooms Not Used for Living

basement or utility room 6. Heating & Plumbing outside 7. Building Exterior overall 8. General Health & Safety

Each part of the checklist will be accompanied by an explanation of the itemto be inspected. Important: For each item numbered on the checklist, check one box only(e.g., check one box only for item 1.4 "Security in the Living Room.) In the space to the right of the description of the item, if the decision on the itemis: Fail write what repairs are necessary; If Inconclusive write in details. Also, if Pass but there are some conditions present that need to be brought tothe attention of the owner or the tenant, write these in the space to the right. If it is an annual inspection, record to the right of the form any repairs madesince the last inspection. If possible, record reason for repair (e.g., ordinarymaintenance, tenant damage). If it is a complaint inspection, fill out only those checklist items for whichcomplaint is lodged. Determine, if possible, tenant or owner cause. Once the checklist has been completed, return to Part B (SummaryDecision on the Unit).

1. Living Room

1.1 Living Room Present Note: If the unit is an efficiency apartment, consider the living roompresent. 1.2 Electricity In order to qualify, the outlets must be present and properlyinstalled in the baseboard, wall or floor of the room. Do not count asingle duplex receptacle as two outlets, i.e., there must be twothese in the room, or one of these plus a permanently installedceiling or wall light fixture . Both the outlets and/or the light must be working. Usually, a roomwill have s ufficient lights or electrical appl iances pl u gged i n tooutlets to determine w orkability. Be s ure light f ixture doe s not fail

just because the bulb is burned out. Do not c o unt any of t h e f o llowing i tems o r f ixtures a s outlets/fixtures: Table or floor lamps (these are not permanent lighfixtures); ceiling lamps plugged into socket; extension cords. If t he el e ctric service to t he unit h as be e n t emporarily t urned ocheck Inconclusive. Contact owner or manager after inspection toverify that electricity functions properly when service is turned on.Record this information on the checklist. 1.3 Electrical Hazards Examples of what this means: broken wiring; non-insulated wiring;frayed w iring; i mproper t ypes of w iring, c onnections or i nsulation;wires lying in or located near standing water or other unsafe places;light fixture hanging from electric wiring without other firm supportor f ixture; missing cover pl a tes on s witches or out lets; badl y cracked outlets; exposed fuse box connections; overloaded circuitsevidenced by frequently blown fuses (ask the tenant). Check Inconclusive if you are uncertain about severity of theproblem and seek expert advice. 1. 4 Security Accessible to o utside m eans: doors o pen to t he outside or t o acommon public hall; windows accessible from the outside (e.g.basement an d first floor); w indows or d o ors l e ading o n to a f ireescape, porch or other outside place that can be r eached from theground. Lockable means: the window or door has a properly working lock,or i s nailed shut, or t he window i s not de s igned to be opened. Astorm window lock that is working properly is acceptable. Windowsthat are nailed shut are acceptable only if these windows are notneeded for ventilation or as an alternate exit in case of fire. 1.5 Window Condition Rate the windows in the room (including windows in doors). Severe det e rioration means t hat t he w indow no l o nger has t hcapacity to keep out the wind and the rain or is a cutting hazard.Examples are: missing or broken-out pan e s; dan gerously loosecracked pan e s; windows that will not close; windows that, when

closed, do not form a reasonably tight seal.

If more than one window in the room is in this condition, give detailsin the space provided on the right of the form. If there is on ly moderate de terioration of t he w indows t he i temshould "Pass." "Moderate deterioration means windows which arereasonably weather-tight, but show evidence of some aging, abuse,or lack of repair. Signs of deterioration are: minor crack in windowpane; s plintered s ill; s igns of some minor r o tting i n th e windowframe or the window itself; window panes loose because of missingwindow putty. Also for deteriorated and peeling paint see 1.9. Ifmore than one window is in this condition, give details in the spaceprovided on the right of the form.

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1.6 Ceiling Condition Unsound or hazardous means the presence of such serious de-fects that either a potential exists for structural collapse or that largecracks or holes allow significant drafts to enter the unit. Thecondition includes: severe bulging or buckling; large holes; missingparts; f a lling or i n da nger of f a lling loose s urface materials ( otherthan paper or paint). Pass ceilings that a re basically s ound but have s somenonhazardous defects, including: small holes or cracks; missing orbroken c e iling tiles; water s tains; s oiled s urfaces; un paintedsurfaces; peeling paint (for peeling paint see item 1.9). 1.7 Wall Condition Unsound or h a zardous i ncludes: serious de fects s uch t hat t hestructural s a fety o f the b u ilding is threatened, such as severebuckling, bulging or leaning; damaged or loose structural members;large holes; air infiltration. Pass walls t hat are bas ically sound b ut hav e s ome non hazardousdefects, including: small or shallow holes; cracks; loose or missingparts; unpainted surfaces; peeling paint (for peeling paint see item 1.9). 1.8 Floor Condition Unsound or hazardous means the presence of such serious defectsthat a potential exists for structural collapse or other threats to safety(e.g., s t ripping) or l a rge cr a cks or hol es al low s ubstantial dr afts f rom

below t he f loor. T he c ondition i ncludes: s e vere buc kling or m a jormovements under walking stress; damaged or missing parts. Pass floors that are basically sound but have some nonhazardousdefects, including: heavily worn or damaged floor surface (for ex-ample,scratches or gouges i n s urface, m issing por tions of tile or linoleum,previous water damage). If there is a floor covering, also note thecondition, especially if badly w orn or soiled. If t here is a f loor covering,including pai nt or s e alant, al so not e the c onditions, specially if badl y worn, soiled or peeling (for peeling paint, see 1.9).

1.9 Lead-Based Paint Housing Choice Voucher Units If the unit was built January 1, 1978, or after, no child under age six will occupy or currentlyoccupies it, is a 0-BR, elderly or handicapped unit with no childrenunder age six on the lease or expected, has been certified lead-based paint free by a certified lead-based paint inspector (no lead-based paint present or no lead-based paint present after removal oflead-based paint.), check NA and do not inspect painted surfaces.

This requirement applies to all painted surfaces (building

components) within the unit. (Do not include tenant belongings).Surfaces to receive a visual assessment for deteriorated paintinclude walls, floors, ceilings, built in cabinets (sink bases),baseboards, doors, door frames, windows systems includingmullions, sills, or frames and any other painted buildingcomponent within the unit. Deteriorated paint includes any paintedsurface that is peeling, chipping, chalking, cracking, damaged orotherwise separated from the substrate.

All deteriorated paint surfaces more than 2 sq. ft. in any one interior room or space, or more than 10% of the total surfacearea of an interior type of component with a small surfacearea (i.e., window sills, baseboards, and trim) must bestabilized (corrected) in accordance with all safe work practicerequirements and clearance is required. If the deteriorated painted surface is less than 2 sq. ft. or less than 10% of thecomponent, only stabilization is required. Clearance testingis not required. Stabilization means removal of deteriorated paint, repair of the substrate, and application of a new protectivecoating or paint. Lead-Based Paint Owner Certification is requiredfollowing stabilization activities, except for de minimis levelrepairs.

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1. Living Room For each numbered item, check one box only.

Item Description If Fail or No. If Fail, what repairs are necessary? Inconclusive,

If Inconclusive, give details. date (mm/dd/yyyy)If Pass with comments, give details. of final approval

1.1 Living Room Present Is there a living room?

1.2 Electricity Are there at least two working outlets or one working outlet and one working light fixture? 1.3 Electrical Hazards Is the room free from electrical hazards? 1.4 Security Are all windows and doors that are accessible from the outside lockable? 1.5 Window Condition Is there at least one window, and are all windows free of signs of severe deterioration or missing or broken out panes?

1.6 Ceiling Condition Is the ceiling sound and free from hazardous defects?

1.7 Wall Condition Are the walls sound and free from hazardous defects?

1.8 Floor Condition Is the floor sound and free from hazardous defects?

1.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint?

If no, does deteriorated surfaces exceed two square Not Applicable feet and/or more than 10% of a component?

Additional Comments: (Give Item Number)

Comments continued on a separate page Yes No

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2. Kitchen

2.1 Kitchen Area Present Note: A kitchen is an area used for preparation of meals. It may beeither a separate room or an area of a l arger room (for example, akitchen area in an efficiency apartment). 2.2 - 2.9 Explanation for these items is the same as that

pro vided f o r " Living R o om with t h e f o llowingmodifications:

2.2 Electricity Note: The requirement is that at least one outlet and onepermanent light fixture are present and working. 2.5 Window Condition Note: The absence of a window does not fail this item in thekitchen. If there is no window, check Pass.

2.10 Stove or Range with Oven Both an ov e n and a stove ( or r a nge) w ith t op bur ners must bepresent and working. If either Is missing and you know that theowner is responsible for supplying these appliances, check Fail.Put check in Inconclusive column if t he tenant is r esponsible forsupplying t he a ppliances a nd he or s he ha s not y e t moved i n.Contact tenant or prospective tenant to gain verification that facility

will be s upplied a nd is in w orking condition. H ot p lates are no t acceptable substitutes for these facilities. An oven i s not working if i t will not heat u p. To be w orking a s toveor range must have all burners working and knobs to turn them offand on. U nder working c ondition, al s o look f or hazardous ga s hook- ups evidenced by s trong ga s s mells; these s hould f ail. ( Besure that this condition is not confused with an unlit pilot light -acondition that should be noted, but does not fail.) If both an oven and a stove or range are present, but the gas orelectricity ar e tu rned of f , check Inconclusive. Contact o w ner ormanager t o g e t verification that facility w orks when gas i s t urnedon. If both an oven and a s tove or r ange are pr esent and working,but defects ex ist, check " Pass" and note these to t he r ight of t he

form. Possible defects are marked, dented, or scratched surfaces;cracked burner ring; limited size relative to family needs. A microwave oven may be substituted for a tenant-supplied ovenand stove (or range). A microwave oven may be substituted for an owner-supplied ovenand stove (or range) if the tenant agrees and microwave ovens arefurnished instead of ov e ns and s toves ( o r r a nges) t o bot h subsidized and unsubsidized tenants in the building or premises.

2.11 Refrigerator If no refrigerator is present, use the same criteria for marking eitherFail or Inconclusive as were used for the oven and stove or range.

A refrigerator is not working if it will not maintain a temperature lowenough to keep food from spoiling over a reasonable period of time.If the el ectricity i s turned of f, mark Inconclusive. Contact ow ner(or tenant if unit is occupied) to get verification of working condition.If the refrigerator is present and working but defects exist, note these tothe right of the form. Possible minor defects include: broken or missing

interior shelving; dented or scratched interior or exterior surfaces; minordeterioration of door seal; loose door handle. 2.12 Sink If a permanently attached kitchen sink is not present in the kitchen orkitchen area, m ark Fail. A sink i n a bat hroom or a por table bas in wnot satisfy this requirement. A sink i s not working unless it has runninghot and c old w a ter f r om t he f a ucets and a pr operly c onnected an d properly w orking dr ain ( with a gas t rap). In a vac a nt apar tment, t hehot w ater m a y h a ve been t urned of f and t here w ill be no h ot wa ter.Mark this Inconclusive. Check with owner or manager to verify that hotwater is available when service is turned on. If a w orking s ink h a s def e cts, note t h is t o the r ight of t he i tem.Possible minor defects include: dripping faucet; marked, dented, or

scratched surface; slow drain; missing or broken drain stopper.

2.13 Space for Storage, Preparation, and Serving of Food Some s pace must be a vailable f or the storage, pr e paration, anserving of f ood. I f t here i s no bui lt-in space for f ood storage apreparation, a t a ble used f or f ood pr e paration and a po rtablestorage cabinet w ill satisfy the r e quirement. I f t here i s no built-ispace, an d no room f or a t a ble an d por table c a binet, c heckInconclusive a nd discuss w ith the tenant. The t enant makes thefinal determination as to whether or not this space is acceptable.If there are some m inor defects, check "Pass" and make notes tothe r ight. P ossible def ects i nclude: m a rked, dent e d, or s cratchedsurfaces; br oken s helving or c a binet do ors; br oken dr a wers orcabinet hardware; limited size relative to family needs.

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2. Kitchen For each numbered item, check one box only.

Item Description No. If Fail, what repairs are necessary?

If Inconclusive, give details. If Pass with comments, give details.

2.1 Kitchen Area PresentIs there a kitchen?

2.2 Electricity

Are there at least one working outlet and one work-ing, permanently installed light fixture? 2.3 Electrical Hazards Is the kitchen free from electrical hazards? 2.4 Security Are all windows and doors that are accessible fromthe outside lockable? 2.5 Window Condition Are all windows free of signs of deterioration ormissing or broken out panes? 2.6 Ceiling Condition Is the ceiling sound and free from hazardous defects?

2.7 Wall Condition Are the walls sound and free from hazardousdefects?

2.8 Floor Condition Is the floor sound and free from hazardous defects?

2.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square

Not Applicable feet and/or less than 10% of a component? 2.10 Stove or Range with Oven Is there a working oven, and a stove (or range) with top burners that work? If no oven and stove (or range) are present, is there a microwave oven and, if microwave is owner-supplied, do other tenants have microwaves instead of an oven and stove (or range)? 2.11 Refrigerator Is there a refrigerator that works and maintainsa temperature low enough so that food does notspoil over a reasonable period of time? 2.12 Sink Is there a kitchen sink that works with hot and cold running water? 2.13 Space for Storage, Preparation, and

Serving

Serving of Food Is there space to store, prepare, and serve food? Additional Comments: (Give Item Number)(Use an additional page if necessary)


If Fail orInconclusive, date(mm/dd/yyyy) offinal approval


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3. Bathroom

3.1 Bathroom Present Most units have easily identifiable bathrooms (i.e., a separate room withtoilet, washbasin and tub or shower). In s ome cases, however, you w illencounter units with scattered bathroom facilities (i.e., toilet. washbasinand tub or s hower located in separate parts of t he unit). At a m inimum,there m ust be an enclosure ar ound t he t oilet. I n t his c ase, count t heenclosure around the toilet as the bathroom and proceed with 3.2-3.9below, w ith r e spect t o this enc losure. I f there i s m ore t han one

bathroom that is normally used, rate the one that is in best condition forPart 3. If t here is a second bathroom that is also used, complete Part 4of the c hecklist f or this r oom. (See I nspection M a nual f or ad ditionalnotes on rating the second bathroom.) 3.2 - 3.9 Explanation for these items is the same as that

pro vided f o r Living R o om w ith t h e f o llowingmodifications:

3.2 Electricity Note: The requirement is that at least one permanent lightfixture is present and working 3.3 Electrical Hazards Note: In addition to the previously mentioned hazards, outletsthat ar e located w here w a ter m ight s plash or c ollect ar e considered an electrical hazard. 3.5 Window Condition Note: The absence of a w indow does not f ail this item in thebathroom (see item 3.13, Ventilation, for relevance of windowwith respect to ventilation). If there is no window, but aworking vent system is present, check Pass. 3.7 Wall Condition Note: Include under nonhazardous defects (that would pass,but should be noted) the following: broken or l oose t ile;deteriorated gr outing at tub/wall and t ub/floor joints, or t iledsurfaces; water stains. 3.8 Floor Condition Note: Include under nonhazardous defects (that would pass, butshould be noted) the following: missing floor tiles; water stains.

3.10 Flush Toilet in Enclosed Room in Unit The toilet must be contained within the unit, be in proper operatingcondition, and be available for the exclusive use of the occupants ofthe unit ( i.e., outhouses or facilities shared by occupants o f otherunits are not acceptable). It must allow for privacy. Not working means: the toilet is not connected to a water supply; it isnot connected to a sewer drain; it is clogged; it does not have a trap;the c onnections, vent s or t r aps ar e faulty t o the ex tent t hat s e vereleakage of w ater or escape of gases oc curs; the flushing mechanismdoes not f unction properly. If t he water to the unit has been t urned off,check " Inconclusive. O btain verification f rom owner or m anager t hatfacility works properly when water is turned on. Comment to t he right of the form i f the t oilet is present, exclusive,and working, but has the following types of defects: constantrunning; chipped or broken porcelain; slow draining. If dr ain b lockage is more s erious and occurs further in t he sewerline, causing backup, check item 7.6, Fail, under the plumbing andheating part of t he checklist. A s ign of s e rious s ewer bl ockage isthe presence of numerous backed-up drains.

3.11 Fixed Wash Basin or Lavatory in Unit The w a sh ba s in m ust be pe r manently i nstalled ( i.e., a p ortablewash basin does not satisfy the requirement). Also, a kitchen sinkused to pass the requirements under Part 2 of the checklist (kitchenfacilities) cannot also serve as the bathroom wash basin. The washbasin may be located separate from the other bathroom facilities(e.g., in a hallway). Not working means: the w a sh b a sin is no t connected t o a system

that will deliver hot and cold running water; it is not connected to aproperly oper a ting dr a in; t he c onnectors ( or v e nts or t r aps) ar e faulty to the extent that severe leakage of water or escape of sewergases occurs. If the water to the unit or the hot water unit has beenturned off, check "Inconclusive." Obtain verification from owner ormanager that the system is in working condition. Comment to the right of t he form if the wash basin is present andworking, but has the following types of minor defects: insufficientwater pressure; dripping faucets; minor leaks; cracked or chippedporcelain; slow drain (see discussion above under 3.10). 3.12 Tub or Shower in Unit Not present means that neither a t ub n or shower is present in t heunit. Again, these facilities need not be in the same room with the

rest of the bathroom facilities. They must, however, be private. Not working covers the same requirements detailed above for washbasin (3.11). Comment to the right of the form if the tub or shower is present andworking, but h a s t he f ollowing t ypes of de f ects: dr ipping faucet;minor leaks; cracked porcelain; slow drain (see discussion under3.10); absent or broken support rod for shower curtain. 3.13 Ventilation Working vent s ystems i nclude: vent ilation s hafts ( non -mechanicalvents) and electric fans. Electric vent fans must function when switch isturned on. (Make sure that any malfunctions are not due to t he fan notbeing plugged in.) If electric current to the unit has not been t urned on(and there is no operable window), check Inconclusive. Obtainverification from owner or m anager that system works. Note: exhaustvents must be vented to the outside, attic, or crawlspace.

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3. Bathroom For each numbered item, check one box only.



3.1 Bathroom Present (See description) Is there a bathroom? 3.2 Electricity

Is there at least one permanently installed light fixture? 3.3 Electrical Hazards Is the bathroom free from electrical hazards? 3.4 Security Are all windows and doors that are accessible fromthe outside lockable? 3.5 Window Condition Are all windows free of signs of deterioration ormissing or broken out panes? 3.6 Ceiling Condition Is the ceiling sound and free from hazardous defects? 3.7 Wall Condition Are the walls sound and free from hazardous defects? 3.8 Floor Condition Is the floor sound and free from hazardous defects? 3.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square

Not Applicable feet and/or more than 10% of a component? 3.10 Flush Toilet in Enclosed Room in Unit Is there a working toilet in the unit for the exclusive private use of the tenant? 3.11 Fixed Wash Basin or Lavatory in Unit Is there a working, permanently installed wash basin with hot and cold running water in the unit? 3.12 Tub or Shower Is there a working tub or shower with hot and cold running water in the unit? 3.13 Ventilation Are there operable windows or a working vent system? Additional Comments: (Give Item Number)(Use an additional page if necessary)



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4. Other Room Used for Living and Halls

Complete an Other R o om checklist for as m a ny other r oomsused for living as are present in the unit and not already noted inParts l, 2, and 3 of t he c hecklist. Se e t h e discussion be low f ordefinition of used for l iving. Also co mplete an Other R o omchecklist for al l en trance ha lls, c o rridors, a n d s taircases t h at ar e located within the unit and are part of the area used for living. If ahall, e n try and/ or stairway ar e c o ntiguous, r a te t hem as a w hole(i.e., as part of one space).

Additional forms for rating Other Rooms are provided in thecheck-list. Definition of used for living." Rooms "used for living are areas ofthe unit that are walked through or lived in on a r egular basis. Donot i nclude r o oms or o ther ar eas that h ave been permanently, ornear permanently, closed off or areas that are infrequently entered.For example, do not include a utility room, attached shed, attachedclosed-in porch, basement, or garage if they are closed off from themain living area or ar e i nfrequently ent ered. D o in clude any ofthese areas if they are frequently used (e.g., a finishedbasement/play-room, a c losed-in porch that is used as a b edroomduring summer months). Occasional use of a washer or dryer in anotherwise unused room does not constitute regular use. If t he uni t is v acant and y ou do n o t know t he eventual u s e of aparticular room, complete an Other Room checklist if there is anychance that the room will be used on a regular basis. If there is nochance that the room will be used on a regular basis, do not includeit (e.g., an unfinished basement) since it will be checked under Part5, All Secondary Rooms (Rooms not used for living). 4.1 Room Code and Room Location Enter the appropriate room code given below: Room Codes: 1 =Bedroom or a n y ot her room used f or sleeping ( regardless of

type of room)2 = Dining Room or Dining Area

3 = Second Living Room, Family Room, Den, Playroom, TV Room

4 = Entrance Halls, Corridors, Halls, Staircases5 =A dditional B a throom ( also check pr e sence of s ink t r ap and

clogged toilet)6 = Other

Room Location: Write on the line provided the location of the room with respect to the units width, length and floor level as if you werestanding outside the unit facing the entrance to the unit: right/left/center: record whether the room is situated to the right,left, or center of the unit. front/rear/center: record whether the room is situated to the back,front or center of the unit. floor level: identify the floor level on which the room is located. If t he unit i s va cant, y o u m a y hav e some difficulty pr edicting t heeventual u s e of a r oom. B e fore giving a ny r oom a code of 1(bedroom), the room must meet all of the requirements for a roomused for sleeping (see items 4. 2 and 4.5).

4.2 - 4.9 E xplanations o f these i t ems ar e t h e s a me as t h oseprovided f o r " Living R o om " w ith t h e f o llowingmodifications:

4.2 Electricity/Illumination If the room code is not a "1," the room must have a means ofnatural or ar tificial i llumination s u ch as a permanent l ightfixture, wall outlet present, or light from a window in the roomor near the room. If any required item is missing, check Fail."If the electricity is turned off, check Inconclusive." 4.5 Window Condition

Any room used for sleeping must have at least one window. Ifthe windows in sleeping rooms are designed to be opened, atleast one window must be operable. The minimum standardsdo not require a window in other rooms. Therefore, if thereis n o w indow in ano ther r oom not us ed for s leeping, checkPass, and note no window in the area for comments. 4.6 Smoke Detectors

At least one battery- operated or hard-wired smoke de tectormust be present and working on each level of the unit,including t he bas e ment, b u t not t he crawl s paces a ndunfinished attic. Smoke detectors m ust be i nstalled in ac cordance with and m eetthe r e quirements of t he N a tional F ire P r otection A s sociationStandard (NFPA) 74 (or its successor standards). If the dwelling unit i s occupied by any hear ing-impaired per-son, smoke detectors must have an al a rm s ystem d esignedfor he aring-impaired per sons as s pecified in N FPA 74 ( osuccessor standards). If the uni t wa s un der H AP contract pr ior to A pril 2 4, 1 993,owners who i nstalled battery-operated or h ard-wired smokedetectors in compliance with HUDs smoke detectorrequirements, including the regulations published on July 30,1992 ( 57 F R 33846), w ill not be r e quired subsequently t ocomply with any additional requirements mandated by NFPA74 (i.e. t he ow ner w ould not be r e quired to install a s mokedetector in a basement not used for living purposes, norwould t h e owner be r e quired t o c h ange t h e l o cation o f th esmoke det e ctors that hav e al r eady been installed on t h eother floors of t he unit). In this case, check Pass and n oteunder comments.

Additional Notes For staircases, the adequacy of light and condition of the stair railsand railings is covered under Part 8 of the checklist (General Healthand Safety)

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4. Other Rooms Used for Living and Halls For each numbered item, check one box only. 4.1 Room Location Room Code ______ right/left/center: the room is situated to the right, left, 1 = Bedroom or Any Other Room Used for Sleeping (regardless of

or center of the unit. type of room) ______ front/rear/center: the room is situated to the back, front 2 = Dining Room or Dining Area

or center of the unit. 3 = Second Living Room, Family Room, Den, Playroom, TV Room ______ floor level: the floor level on which the room is 4 = Entrance Halls, Corridors, Halls, Staircases

located. 5 = Additional Bathroom (also check presence of sink trap andclogged toilet)

6 = Other:



4.2 Electricity/Illumination If Room C ode i s a 1, ar e there at l e ast t w o w orkingoutlets or one w orking out let and on e working,permanently installed light fixture? If Room Code is not a 1, is there a means of illumination?

4.3 Electrical Hazards Is the room free from electrical hazards? 4.4 Security Are all windows and doors that are accessible fromthe outside lockable? 4.5 Window Condition If Room Code is a 1, is there at least one window? And, r e gardless of R oom C ode, ar e al l windowsfree of si gns of s e vere de terioration or m issing orbroken-out panes? 4.6 Ceiling Condition Is the ceiling sound and free from hazardous defects?

4.7 Wall Condition Are the walls sound and free from hazardous defects? 4.8 Floor Condition Is the floor sound and free from hazardous defects? 4.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square

Not Applicable feet and/or more than 10% of a component? 4.10 Smoke Detectors Is there a working smoke detector on each level? Do the smoke detectors meet the requirements of NFPA 74? In units occupied by the hearing impaired, is there an alarm system connected to the smoke detector? Additional Comments: (Give Item Number)(Use an additional page if necessary)



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4. Supplemental for Other Rooms Used for Living and Halls For each numbered item, check one box only. 4.1 Room Location Room Code ______ right/left/center: the room is situated to the right, left, 1 = Bedroom or Any Other Room Used for Sleeping (regardless of




6 = Other:



4.2 Electricity/Illumination If Ro om C o de i s a 1, ar e th ere at le ast t w o w o rkingoutlets or one w o rking out let and o n e w o rking,permanently installed light fixture? If Room Code is not a 1, is there a means of illumination?

4.3 Electrical Hazards Is the room free from electrical hazards? 4.4 Security Are all windows and doors that are accessible fromthe outside lockable? 4.5 Window Condition If Room Code is a 1, is there at least one window? And, r e gardless of R o om C o de, ar e al l w indowsfree of s igns of s e vere d eterioration or m issing orbroken-out panes? 4.6 Ceiling Condition Is the ceiling sound and free from hazardous defects?

4.7 Wall Condition Are the walls sound and free from hazardous defects? 4.8 Floor Condition Is the floor sound and free from hazardous defects?




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6 = Other:










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6 = Other:










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5. All Secondary Rooms (Rooms not used for living)

5. Secondary Rooms (Rooms not used for living) If any room in the unit did not meet the requirements for otherroom used for living" in Part 4, it is to be considered a secondaryroom (not used for living), Rate all of these rooms together (i.e., asingle Part 5 checklist for all secondary rooms in the unit). Inspection i s required of t he following t wo items since hazardousdefects u n der t h ese i tems could j e opardize t h e r e st of t h e uni t,even i f pr e sent i n r o oms no t us e d f o r living: 5. 2 S ecurity, 5. 3Electrical H a zards. A lso, be obs e rvant o f any o ther potentiallyhazardous features in these rooms and record under 5.4 5.1 None If there are no Secondary Rooms (rooms not used for living),check "None" and go on to Part 6. 5.2 - 5.4 Explanations of these items is the same as those

provided for Living Room Additional Note In recording other potentially hazardous features, note ( in thespace provided) the means of access to the room with the hazardand c heck t he box under Inconclusive. Discuss the hazard withthe HA inspection supervisor to determine Pass or Fail. Include

defects like: large h

oles i

n f loor, w

alls or ceilings; evidence ofstructural c o llapse; w indows i n c o ndition o f s e vere d e terioration;

and deteriorated paint surfaces.

6. Building Exterior

6.1 Condition of Foundation Unsound or hazardous means foundations with severe structuraldefects i n dicating the pot e ntial for s tructural c o llapse; orfoundations t h at al low s ignificant ent r y of gr o und w a ter ( f orexample, evidenced by flooding of basement). 6.2 Condition of Stairs, Rails, and Porches "Unsound or hazardous" means: stairs, porches, balconies, or

decks w ith s evere s tructural def e cts; broken, r o tting, or missingsteps; ab sence of a han drail when there ar e extended lengths o fsteps ( generally f o ur or more c o nsecutive s teps); ab s ence of orinsecure railings around a porch or balcony which is approximately30 inches or more above the ground. 6.3 Condition of Roof and Gutters Unsound and hazardous m eans: The roof has s erious def ectssuch as serious buckling or sagging, i ndicating the pot ential ofstructural collapse; large holes or other defects that would result insignificant a ir or w a ter i nfiltration ( in most cases s evere exteriordefects will be reflected in equally serious surface defects within theunit, e. g., buckling, w ater damage). The g utters, downspouts andsoffits ( area under t e e eav e s) show s s e rious de c ay and h a veallowed the entry of significant air or water into the interior of thestructure. G u tters and dow nspouts ar e, how ever, not r e quired t o pass. If the roof is not observable and there is no sign of interiorwater damage, check Pass.

6.4 Condition of Exterior Surfaces

See definition above for roof, item 6.3.

6.5 Condition of Chimney

The chimney should not be seriously leaning or showing evidenceof significant disintegration (i.e., many missing bricks). 6.6 Lead-Based Paint: Exterior Surfaces Housing Choice Voucher Units If the unit was built January 1, 1978 or after, no child under age six will occupy or currently occupies, is a 0-BR, elderly or handicapped unit with no childrenunder age six on the lease or expected, has been certified lead-based paint free by a certified lead-based paint inspector (no lead-based paint present or no lead -based paint present after removalof lead), check NA and do not inspect painted surfaces . Visualassessment for deteriorated paint applies to all exterior paintedsurfaces (building components) associated with the assisted unitincluding windows, window sills, exterior walls, floors, porches,railings, doors, decks, stairs, play areas, garages, fences or otherareas if frequented by children under age six.

All deteriorated paint surfaces more than 20 sq. ft. on exterior surfaces must be stabilized (corrected) in accordance with all sawork practice requirements. If the painted surface is less than

20 sq. ft., only stabilization is required. Clearance testing isnot required. Stabilization means removal of deteriorated paint,repair of the substrate, and application of a new protective coatingor paint. Lead-Based Paint Owner Certification is requiredfollowing stabilization activities except for de minimis level repairs

6.7 Manufactured Homes: Tie Downs Manufactured homes must be placed on a site in a stable mannerand be f r ee f r om haz a rds such a s s liding and w ind damage.Manufactured ho mes m u st be s ecurely an chored by a tie dow ndevice which distributes and transfers the loads imposed by the unitto appropriate ground anchors so as to resist wind overturning andsliding, unless a variation has been approved by the HUD Field

Office.

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5. All Secondary Rooms (Rooms not used for living) For each numbered item, check one box only.


If Inconclusive, give details. date (mm/dd/yyyyIf Pass with comments, give details. of final approval

5.1 None Go to Part 6

5.2 Security Are all windows and doors that are accessible from the outside lockable? 5.3 Electrical Hazards Are all these rooms free from electrical hazards? 5.4 Other Potentially Hazardous Features Are all of these rooms free of any other potentially hazardous features? For each room with an "other potentially hazardous feature," explain the hazard and the means of control of interior access to the room.

6.0 Building Exterior 6.1 Condition of Foundation Is the foundation sound and free from hazards?

6.2 Condition of Stairs, Rails, and Porches Are all the exterior stairs, rails, and porches sound and free from hazards? 6.3 Condition of Roof and Gutters Are the roof, gutters, and downspouts sound and free from hazards? 6.4 Condition of Exterior Surfaces Are exterior surfaces sound and free from hazards? 6.5 Condition of Chimney Is the chimney sound and free from hazards? 6.6 Lead-Based Paint: Exterior Surfaces

Are all painted surfaces free of deteriorated paint?

If no, does deteriorated surfaces exceed 20 sq. ft. of Not Applicable total exterior surface area?

6.7 Manufactured Homes: Tie Downs If the unit is a manufactured home, is it properly placed and tied down? If not a manufactured home, check

Not Applicable "Not Applicable."

Additional Comments: (Give Item Number)(Use an additional page if necessary)



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7. Heating and Plumbing

7.1 Adequacy of Heating Equipment Adequate heat means that the heating system is capable ofdelivering enough heat to a ssure a healthy environment in the unit(appropriate to the climate). The HA is responsible for defining whatconstitutes a healthy living environment in the area of the country inwhich it operates. Local codes (city or state codes) should beinstructive in ar riving at a reasonable local definition. For example,for heat adequacy, local codes often require that the units heatingfacility be capable of maintaining a given temperature level during adesignated time period. Portable electric room heaters or kitchenstoves or ranges with a built-in heat unit are not acceptable as aprimary s ource of h e at f or units located in ar eas w here c limateconditions require regular heating. Directly or indirectly to all rooms used for living means:

Directly m e ans t hat each r oom u s ed for l iving h a s a hea t source (e.g., working radiator; working hot air register;baseboard heat) indirectly means that, if t here is n o heat source present inthe room, heat can enter the room easily from a heatedadjacent r oom ( e.g a dining room may not hav e a r adiator,but would receive heat from the heated living room through alarge open archway).

If the heating system in the unit works, but t here is some questionwhether a r o om w ithout a h e at s o urce w ould r e ceive a de quateindirect heat, check Inconclusive and verify adequacy from tenantor owner (e.g., unheated bedroom at the end of a long hallway).

How to determine the capability of the heating system: If the unit isoccupied, usually the quickest way to determine the capability ofthe heating system over time is to question the tenant. If the unit isnot oc cupied, or t he t e nant has n o t lived i n the unit d u ring t hemonths when heat would be needed, check Inclusive. It will benecessary to question the owner on this point after the inspectionhas been completed and, if possible, to question other tenants (if itis a muIti-unit structure) about the adequacy of he at pr ovided.Under s ome circumstances, the ade quacy of he at can be det er-mined by a simple comparison of the size of the heating system tothe area to be heated. For example, a small permanently installedspace heater in a l iving r oom i s pr obably inadequate f or heat inganything larger than a relatively small apartment. 7.2 Safety of Heating Equipment Examples of unvented fuel burning space heaters are: portablekerosene units; unvented open flame portable units. Other unsafe conditions include: breakage or damage to heatingsystem such t hat t here i s a potential f o r f ire or ot her t hreats t osafety; i m proper c onnection of f lues al lowing ex haust ga ses t oenter t he l iving area; improper i nstallation of e quipment ( e.g.,proximity of fuel t ank t o heat s ource, absence of safety d evices);indications of i mproper use of equipment ( e.g., evidence of heavybuild-up of soot, creosote, or other substance in the chimney);disintegrating equipment; c ombustible materials ne ar h eat s ourceor flue. See Inspection Manual for a more detailed discussion of theinspection of safety aspects of the heating systems. If you are un able t o gain access to the pr imary heating system inthe unit check Inconclusive." C ontact t he ow ner or manager forverification of safety of t he s ystem. If t he s ystem has pa s sed arecent l ocal inspection, check Pass. T h is app p ies especially t ounits i n w hich heat i s provided by a l a rge scale, c omplex centralheating system that s erves multiple u nits ( e.g., a boi ler i n thebasement of a l a rge apa rtment bu ilding). I n most cases, a l a rgescale he ating s ystem f or a multi-unit bui lding w ill be s ubject t operiodic safety inspections by a local public agency. Check with theowner or manager to determine the date and outcome of the lastsuch inspection, or look for an i nspection certificate posted on t heheating system.

7.3 Ventilation and Adequacy of Cooling If the tenant is present and has occupied the unit during thesummer months, inquire about the adequacy of air flow. If thetenant is not present or has not occupied the unit during thesummer months, test a sample of windows to see that they open(see Inspection Manual for instruction). Working cooling equipment includes: central (fan) ventilation system;evaporative cooling system; room or central air conditioning. Check Inconclusive i f th ere ar e n o op e rable w indows a nd i t is

impossible, or i n appropriate, t o te st w h ether a c o oling systemworks. C h eck w ith ot her t e nants i n the bu ilding ( in a m uIti-unitstructure) a nd w ith t h e ow ner or m a nager f o r v e rification of t headequacy of ventilation and cooling. 7.4 Water Heater "Location presents hazard means that the gas or oil water heateris located in living areas or closets where safety hazards may exist(e.g., water heater located in very cluttered closet with cloth andpaper items stacked against it). Gas water heaters in bedrooms orother living areas must have safety dividers or shields. Water heaters must have a temperature- pressure relief valve anddischarge line ( directed t oward t he f loor or out side o f t he l ivarea) as a safeguard against build up of steam if the water heatermalfunctions. If not, they are not properly equipped and shall fail.

To pas s, ga s or oi l f ired w ater heat e rs must b e ve nted i nto aproperly i nstalled chimney or f lue leading outside. E lectric w aterheaters do not require venting. If it is impossible to view the water heater, check Inconclusive.Obtain verification of safety of system from owner or manager. Check "Pass" i f t he w a ter he ater ha s pas sed a l ocal i nspection.This applies primarily to hot water that is s upplied by a l arge scalecomplex water heating system that serves multiple units (e.g.,water heat ing s ystem in large apar tment bu ilding). C heck i n thsame manner described for heating system safety, item 7.2, above.7.5 Water Supply If the s tructure is c onnected t o a c ity or t own w a ter s ystem, c heckPass. I f the s tructure has a pr ivate w a ter s upply ( usually i n r uralareas) inquire into the nature of the supply (probably from the owner)

and whether it is approvable by an appropriate public agency. General note: If items 7.5, 7.6, or 7,7 are checked Inconclusive,check with owner or manager for verification of adequacy. 7.6 Plumbing Major leaks m eans t hat main water dr ain and f e ed pi pes ( oftelocated i n the basement) ar e seriously l eaking. (Leaks present atspecific facilities have already been evaluated under the checklistitems for Bathroom and Kitchen.) Corrosion ( causing serious and per s istent l e vels o f r ust orcontamination in the drinking water) can be determined byobserving t he color of the dr inking w a ter at s s veral t a ps. B adlycorroded pipes will produce noticeably brownish water. If the tenantis currently occupying the unit, he or she should be able to provideinformation about the persistence of this condition. (Make sure that

the rusty water is not a temporary condition caused by city or townmaintenance of main water lines.) See general note under 7.5. 7.7 Sewer Connection If the structure is connected to the city or town sewer system, checkPass. I f t he structure ha s i ts own pr ivate di sposal system (e.g.,septic f ield), i nquire i nto t he nature of t he system a nd determinewhether this type of system can meet appropriate health and safetyregulations. The following conditions constitute evidence of sewer back up:strong sewer gas smell in t he ba s ement or outside of uni t;numerous clogged or very slow drains; marshy areas outside of unitabove septic field. See general note under 7.5.

Previous editions are obsolete Page 1 6 of 1 9 ref Handbook 7420.8 form HUD-52580 (09/1


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7. Heating and Plumbing For each numbered item, check one box only.



7.1 Adequacy of Heating Equipment Is the heating equipment capable of providing adequate heat (either directly or indirectly) to all rooms used for living? 7.2 Safety of Heating Equipment Is the unit free from unvented fuel burning space heaters or any other types of unsafe heating conditions? 7.3 Ventilation and Adequacy of CoolingDoes t he uni t hav e adequat e ve ntilation and c ooling by

means of openable windows or a working cooling system?

7.4 Water HeaterIs the water heater located, equipped, and installedin a safe manner? 7.5 Water Supply Is the unit served by an approvable public or private

sanitary water supply?

7.6 Plumbing Is plumbing free from major leaks or corrosion thatcauses serious and persistent levels of rust or con-tamination of the drinking water? 7.7 Sewer Connection Is plumbing connected to an approvable public orprivate disposal system, and is it free from sewerback-up? Additional Comments: (Give Item Number)



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8. General Health and Safety

8.1 Access to Unit Through another unit means that access to the unit Is onlypossible by means of passage through another dwelling unit. 8.2 Exits Acceptable fire exit means that the building must have an alterna-tive m eans of exit t hat meets l ocal or S tate regulations in case offire; this could include:

An openable window if the unit is on the first floor or secondfloor or easily accessible to the ground.

A back door opening on to a porch with a stairway leading tothe ground.

Fire escape, fire ladder, or fire stairs. Blocked means that the exit is not useable due to conditions suchas debris, storage, door or window nailed shut, broken lock. Important n o te: T h e H A ha s the f inal r e sponsibility f or d e cidingwhether t he t ype of e mergency ex it is ac ceptable, al though t hetenant should assist in making the decision. 8.3 Evidence of Infestation Presence of rats, or severe infestation by mice or vermin (such asroaches) is evidenced by: rat holes; droppings; rat runs; numeroussettings of rat poison. If the unit is occupied, ask the tenant, 8.4 Garbage and Debris Heavy ac cumulation means l a rge p iles o f tr ash and ga rbage,discarded f urniture, an d ot her debr is ( not t e mporarily s toredawaiting removal) that might harbor rodents, This may occur insidethe u ni t, in common areas, or outside. It usually means a l evel ofaccumulation beyond the capacity of an individual to pick up withinan hour or two. 8.5 Refuse Disposal Adequate covered facilities" includes: trash cans with covers, gar-bage chutes, dumpsters (i.e., large scale refuse boxes with lids);trash ba gs (if a pprovable by l ocal p ublic ag ency). ApprovabIe bylocal p ublic agency m eans t hat t he l o cal H e alth and S anitationDepartment ( city, t own or c ounty) ap proves t he t ype of f acility i nuse. Note: During the period when the HA is setting up itsinspection program, it will check with the local health and sanitation

department t o determine w hich t ypes of f a cilities ar e acceptableand include this in the inspection requirements. If the unit is vacant and there are no adequate covered facilitiespresent, c h eck Inconclusive. C o ntact t he ow ner or m a nager f orverification of facilities provided when the unit is occupied. 8.6 Interior Stairs and Common Halls Loose, broken, or missing steps should fail if they present aserious risk of tripping or falling. A handrail is required on extended sections of stairs (generally fouror more consecutive steps). A railing is required on unprotectedheights such as around stairwells. Other hazards would be conditions such as bare electrical wiresand tripping hazards. Housing Choice Voucher Units If the unit was built January 1,1978, or after, no child under six will occupy or currently occupiesit, is a 0-BR, elderly or handicapped unit with no children under sixon the lease or expected, has been certified lead-based paint freeby a certified lead-based paint inspector (no lead-based paintpresent or no lead-based paint present after removal of lead-basedpaint.), check NA and do not inspect painted surfaces.

This requirement applies to all painted surfaces (building compo-nents) within the unit. (Do not include tenant belongings).Surfaces to receive a visual assessment for deteriorated paintinclude walls, floors, ceilings, built in cabinets (sink bases),baseboards, doors, door frames, windows systems including

mullions, sills, or frames and any other painted building compo-nent within the unit. Deteriorated paint includes any paintedsurface that is peeling, chipping, chalking, cracking, damaged orotherwise separated from the substrate.

All deteriorated paint surfaces more than 2 sq. ft. in any one interior room or space, or more than 10% of the total surfacearea of an interior type of component with a small surfacearea (i.e., window sills, baseboards, and trim) must be stabi-lized (corrected) in accordance with all safe work practicerequirements and clearance is required. If the deteriorated painted surface is less than 2 sq. ft. or less than 10% of thecomponent, only stabilization is required. Clearance testingis not required. Stabilization means removal of deteriorated paint, repair of the substrate, and application of a new protectivecoating or paint. Lead-Based Paint Owner Certification is requiredfollowing stabilization activities, except for de minimis levelrepairs.

8.7 Other Interior Hazards Examples of o ther haz a rds might be: a br oken ba throom f ixturewith a s h arp edge in a location w h ere i t r e presents a haz a rd; aprotruding nail in a doorway. 8.8 Elevators Note: At the t ime the HA is setting up i ts inspection program, it w ill

determine local licensing practices for elevators. lnspectors shouldthen be aware of these practices in evaluating this item (e.g., checkinspection date). If no elevator check Not Applicable. 8.9 Interior Air Quality If the i nspector has any questions about whether an existing pa ir quality condition should be considered dangerous, he or sheshould ch eck w ith the l o cal Health an d S a fety De partment ( city,town or county). 8.10 Site and Neighborhood Conditions Examples of conditions that would seriously and continuouslyendanger the health or safety of the residents are:

other buildings on, or near the property, that pose serioushazards ( e.g., di lapidated s h ed or gar a ge with pot e ntial f ostructural collapse), evidence of flooding or major drainage problems, evidence of mud slides or large land settlement or collapse,proximity to open sewage, unprotected heights (cliffs, quarries, mines, sandpits),fire hazards, abnormal air pollution or smoke which continues throughoutthe year and is determined to seriously endanger health, andcontinuous or excessive vibration of vehicular traffic (if theunit is occupied, ask the tenant).

8.11 Lead-Based Paint: Owner Certification If the owner is required to correct any lead- based paint hazards atthe property including deteriorated paint or other hazards identi-fied

by a visual assessor, a certified lead-based paint risk asses-sor, orcertified lead -based paint inspector, the PHA must obtaincertification that the work has been done in accordance with allapplicable requirements of 24 CFR Part 35. The Lead -Based PaintOwner Certification must be received by the PHA before theexecution of the HAP contract or within the time period stated bythe PHA in the owner HQS violation notice. Receipt of thecompleted and signed Lead-Based Paint Owner Certificationsignifies that all HQS lead-based paint requirements have beenmet and no re-inspection by the HQS inspector is required.



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8. General Health and Safety For each numbered item, check one box only.

Item Description No. If Fail, what repairs are necessary?

If Inconclusive, give details. If Pass with comments, give details.

8.1 Access to Unit Can the unit be entered without having to go through another unit?

8.2 Exits

Is there an acceptable fire exit from this buildingthat is not blocked? 8.3 Evidence of Infestation Is the unit free from rats or severe infestation bymice or vermin? 8.4 Garbage and Debris Is the unit free from heavy accumulation of garbageor debris inside and outside? 8.5 Refuse Disposal Are there adequate covered facilities for temporarystorage and disposal of food wastes, and are theyapprovable by a local agency? 8.6 Interior Stairs and Common Halls Are interior stairs and common halls free from haz-ards to the oc cupant because of loose, br oken, ormissing steps on stairways; absent or insecure rail-ings; inadequate lighting; or other hazards? 8.7 Other Interior Hazards Is the interior of the unit free from any other hazardnot specifically identified previously? 8.8 Elevators Where local practice requires, do all elevators have a current inspection certificate? If local practice

Not Applicable does not require this, are they working and safe? 8.9 Interior Air Quality Is the unit free from abnormally high levels ofair pollution from vehicular exhaust, sewer gas,fuel gas, dust, or other pollutants? 8.10 Site and Neighborhood Conditions Are the site and immediate neighborhood free from conditions which would seriously and continuously endanger the health or safety of the residents? 8.11 Lead-Based Paint: Owner Certification If the owner of the unit is required to correct any deteriorated paint or lead-based paint hazards at the property, has the Lead-Based Paint Owners Certification been completed, and received by the PHA? If the owner was not required to correct

Not Applicable any deteriorated paint or lead-based paint hazards, check NA. Additional Comments: (Give Item Number)


If Fail orInconclusive, date(mm/dd/yyyy) offinal approval

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Department of Housing and Urban Development Inspection Form 52580

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