Housing Choice Voucher Program Inspection Form Page 4
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191.
Living Room
For each numbered item, check one box only.
Decision
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
Previous editions are obsolete
Page 4 of 19
ref Handbook 7420.8 form HUD-52580-A (9/00)
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