Housing Choice Voucher Program Inspection Form Page 8
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193.
Bathroom
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
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 from
the outside lockable?
3.5
Window Condition
Are all windows free of signs of deterioration or
missing 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 sys-
tem?
Additional Comments: (Give Item Number)(Use an additional page if necessary)
Comments continued on a separate page
Yes
No
Previous editions are obsolete
Page 8 of 19
ref Handbook 7420.8 form HUD-52580-A (9/00)
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