Housing Choice Voucher Program Inspection Form Page 2
Download a blank fillable Housing Choice Voucher Program Inspection Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Housing Choice Voucher Program Inspection Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
191.
Living Room
B. Summary Decision on the Unit
1.1
Living Room Present
(to be completed after the form has been filled in)
Note: If the unit is an efficiency apartment, consider the living room
Housing Quality Standard Pass or Fail
present.
1. Fail If there are any checks under the column headed “Fail” the unit
1.2
Electricity
fails the minimum housing quality standards. Discuss with the owner the
In order to qualify, the outlets must be present and properly
repairs noted that would be necessary to bring the unit up to the standard.
installed in the baseboard, wall or floor of the room. Do not count a
2. Inconclusive If there are no checks under the column headed
single duplex r eceptacle as two out lets, i.e., there must be two of
“Fail”
these in the room, or one of these plus a permanently installed
and there are checks under the column headed “Inconclusive,” obtain
ceiling or wall light fixture.
additional information necessary for a decision (question owner or tenant as
indicated in t he i tem i nstructions gi ven in this c hecklist). O nce additional
Both the outlets and/or the light must be working. Usually, a room
information is obtained, change the rating for the item and record the date of
will have sufficient lights or electrical appliances plugged into
verification at the far right of the form.
outlets t o determine w orkability. B e s ure light f ixture doe s not f ail
3. Pass If neither ( 1) nor ( 2) above is checked, the unit passes the
just because the bulb is burned out.
minimum housing quality standards. Any additional conditions described in the
Do not count any of the following items or fixtures as
right hand column of the form should serve to (a) establish the precondition of the
outlets/fixtures: Table or floor lamps (these are not permanent light
unit, (b) indicate possible additional areas to negotiate with the owner,
fixtures); ceiling lamps plugged into socket; extension cords.
(c) ai d i n assessing the r easonableness of the r ent of t he uni t, and ( d) ai d
If t he electric service to t he unit h as been t emporarily turned of f
the tenant in deciding among possible units to be rented. The tenant is
check ‘’Inconclusive.’’ Contact owner or manager after inspection to
responsible for deciding whether he or she finds these conditions
acceptable.
verify that electricity functions properly when service is turned on.
Record this information on the checklist.
Unit Size: Count the number of bedrooms for purposes of the
1.3
Electrical Hazards
FMR or Payment Standard. Record in the box provided.
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 support
or fixture; missing cover plates on switches or outlets; badly
Year Constructed: Enter from Line 5 of the
cracked outlets; exposed fuse box connections; overloaded circuits
Request for Tenancy Approval form. Record in the box provided.
evidenced by frequently ‘’blown’’ fuses (ask the tenant).
Check “Inconclusive’’ if you are uncertain about severity of the
Number of Sleeping Rooms: Count the number of rooms which
problem and seek expert advice.
could be used for sleeping, as identified on the checklist. Record in the box
1. 4
Security
provided.
C. How to Fill Out This Checklist
“Accessible t o o utside” m eans: d oors o pen t o t he o utside or t o a
common public hall; windows accessible from the outside (e.g.
Complete the checklist on the unit to be occupied (or currently occupied) by
the tenant. Proceed through the inspection as follows:
basement and first floor); windows or doors leading onto a fire
Area
Checklist Category
escape, porch or other outside place that can be r eached from the
ground.
room by room
1. Living Room
“Lockable” means: the window or door has a properly working lock,
2. Kitchen
or is nailed shut, or t he window i s not designed to be opened. A
3. Bathroom
storm window lock that is working properly is acceptable. Windows
4. All Other Rooms Used for Living
that are nailed shut are acceptable only if these windows are not
5. All Secondary Rooms Not Used for Living
needed for ventilation or as an alternate exit in case of fire.
basement or utility room
6. Heating & Plumbing
1.5
Window Condition
outside
7. Building Exterior
Rate the windows in the room (including windows in doors).
overall
8. General Health & Safety
“Severe deterioration” means that t he w indow no longer has the
capacity to keep out the wind and the rain or is a cutting hazard.
Examples are: missing or broken-out panes; dangerously loose
cracked panes; 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 details
Each part of the checklist will be accompanied by an explanation of the item
in the space provided on the right of the form.
to be inspected.
If there i s only “ moderate deterioration” of the w indows the item
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.)
should "Pass." "Moderate deterioration” means windows which are
In the space to the right of the description of the item, if the decision on the item
reasonably weather-tight, but show evidence of some aging, abuse,
is: “Fail” write what repairs are necessary; If “Inconclusive” write in details.
or lack of repair. Signs of deterioration are: minor crack in window
Also, if ”Pass” but there are some conditions present that need to be brought to
pane; splintered sill; signs of some minor rotting in the window
the attention of the owner or the tenant, write these in the space to the right.
frame or the window itself; window panes loose because of missing
If it is an annual inspection, record to the right of the form any repairs made
window putty. Also for deteriorated and peeling paint see 1.9. If
since the last inspection. If possible, record reason for repair (e.g., ordinary
more than one window is in this condition, give details in the space
maintenance, tenant damage).
provided on the right of the form.
If it is a complaint inspection, fill out only those checklist items for which
complaint is lodged. Determine, if possible, tenant or owner cause.
Once the checklist has been completed, return to Part B (Summary
Page 2 of 19
Decision on the Unit).
Previous editions are obsolete
ref Handbook 7420.8 form HUD-52580-A (9/00)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business