Form 89 Hqs PDF Details

The Housing Quality Standards (HQS) Inspection Form, also known as Form 89, is a critical document utilized by the Kentucky Housing Corporation to ensure that homes meet essential health and safety criteria. This form encompasses a thorough inspection that covers various aspects of a property, including electrical systems, security, window conditions, ceiling, wall and floor conditions, and specifically looks for lead-based paint violations in properties built prior to 1978. It details a clear protocol for inspectors to follow, documenting whether each inspected room—living room, kitchen, bathroom, and other living areas—passes or fails the set standards. If a property fails the inspection, the form specifies the reasons for failure and stipulates the need for necessary repairs in order to meet the HQS requirements. Additionally, it addresses the issue of deteriorated paint and its implications in accordance with Lead-Based Paint Regulations, significantly impacting properties constructed before 1978. The form serves as a comprehensive tool for inspectors to certify that a property is safe, secure, and suitable for housing, ultimately leading to the final inspection where repaired items are re-evaluated to ensure compliance with housing quality standards.

QuestionAnswer
Form NameForm 89 Hqs
Form Length11 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 45 sec
Other namesForm89.pdf n hqs inspection kentucky form

Form Preview Example

Form 89 – HQS Inspection Form

KENTUCKY HOUSING CORPORATION

HOUSING QUALITY STANDARD INSPECTION FORM

Date of Inspection: __________________

Property Address:

Property City/State/Zip:

Borrower Name(s):Reservation #:

Lender:

--------------------------------------------------------------------------------------------------------------------------------------------------------

A Housing Quality Standards (HQS) inspection of the above-property has been conducted. The status of this inspection is:

Property Passed HQS

Property Failed HQS (note items below)

--------------------------------------------------------------------------------------------------------------------------------------------------------

PROPERTY VIOLATIONS

The following items have failed HQS inspection: ______________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

DETERIORATED PAINT VIOLATIONS (Only required if property was built prior to 1978)

Chipped and peeling paint on interior or exteriors surfaces is present. Areas of concern on:

Interior surfaces: ________________________________________________________________________

_______________________________________________________________________________________

Exterior surfaces: ______________________________________________________________________

_______________________________________________________________________________________

Exceeds

Does Not Exceed

The de minimis levels of the Lead-Based Paint Regulations.**

**20 ft.2 (2m2) on exterior surfaces;

2 ft.2 (0.2 m2) in any one interior room or space; or

10 percent of the total surface area, like window sills, baseboards and trim.

--------------------------------------------------------------------------------------------------------------------------------------------------------

 

_______________________________________

Fee Charged for Inspection: $200

Inspector Signature

--------------------------------------------------------------------------------------------------------------------------------------------------------

FINAL INSPECTION

I certify that the above repair items have been repaired and the property now passes inspection.

Date of Final Inspection ____________________________

Inspector’s Initials ______________

10/20/06

Page 1

Form 89 – HQS Inspection Form

Property Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Living Room

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

 

Pass

Fail

 

 

If Fail, what repairs are necessary?

 

If Fail, Date of

 

 

 

 

 

Final

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

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 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 the deteriorated surfaces exceed 2

 

 

 

 

 

 

 

 

 

 

 

square feet of entire room or more than 10%

 

 

 

 

 

 

 

 

Not Applicable

 

 

of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10/20/06

Page 2

Form 89 – HQS Inspection Form

2. Kitchen

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

 

Pass

 

Fail

 

 

 

If Fail, what repairs are necessary?

If Fail, Date

 

 

 

 

 

 

of Final

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1 Kitchen Present?

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a kitchen?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2 Electricity

 

 

 

 

 

 

 

 

 

 

 

 

 

Are there at least two working outlets or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

one working outlet and one working light

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fixture?

 

 

 

 

 

 

 

 

 

 

 

 

 

2.3 Electrical Hazards

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the room free from electrical hazards?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.4 Security

 

 

 

 

 

 

 

 

 

 

 

 

 

Are all windows and doors that are

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

accessible from the outside lockable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.5 Window Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there at least one window, and are all

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

windows free of signs of severe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

deterioration or missing or broken 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hazardous defects?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 the deteriorated surfaces exceed

 

 

 

 

 

 

 

 

 

 

 

 

2 square feet of entire room or more than

 

 

 

 

 

 

 

 

 

 

Not Applicable

 

10% of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.10Stove or Range with Oven

 

 

 

 

 

 

 

 

 

 

 

 

 

If the sales contract states the stove will

 

 

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

 

 

remain then answer the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a working oven and a stove (or

 

 

 

 

 

 

 

 

 

 

 

 

range) with top burners that work?

 

 

 

 

 

 

 

 

 

 

 

 

 

2.11Refrigerator

 

 

 

 

 

 

 

 

 

 

 

 

 

If the sales contract states the refrigerator

 

 

 

 

 

 

 

 

 

 

Not Applicable

 

will remain then answer the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a refrigerator that works and

 

 

 

 

 

 

 

 

 

 

 

 

maintains a temperature low enough so that

 

 

 

 

 

 

 

 

 

 

 

 

food does not spoil 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 of Food

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a space to store, prepare, and serve

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

food?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 3

Form 89 – HQS Inspection Form

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

 

3. Bathroom

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

 

Pass

 

Fail

 

 

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

 

 

 

Final

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

3.1 Bathroom Present?

 

 

 

 

 

 

 

 

 

 

 

 

Is there a bathroom?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.2 Electricity

 

 

 

 

 

 

 

 

 

 

 

 

Are there at least two working outlets or one

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

working outlet and one working light

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fixture?

 

 

 

 

 

 

 

 

 

 

 

 

3.3 Electrical Hazards

 

 

 

 

 

 

 

 

 

 

 

 

Is the room free from electrical hazards?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.4 Security

 

 

 

 

 

 

 

 

 

 

 

 

Are all windows and doors that are

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

accessible from the outside lockable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.5 Window Condition

 

 

 

 

 

 

 

 

 

 

 

 

Is there at least one window, and are all

 

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

 

windows free of signs of severe deterioration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or missing or broken panes?

 

 

 

 

 

 

 

 

 

 

 

 

Are the windows openable or a working vent

 

 

 

 

 

 

 

 

 

 

 

system?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 the deteriorated surfaces exceed 2

 

 

 

 

 

 

 

 

 

 

 

square feet of entire room or more than 10%

 

 

 

 

 

 

 

 

 

Not Applicable

 

of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.10 Flush Toilet in Enclosed Room

 

 

 

 

 

 

 

 

 

 

 

Is there a working toilet?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.11 Fixed Wash Basin or Lavatory

 

 

 

 

 

 

 

 

 

 

 

Is there a working, permanently installed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

wash basin with hot and cold running water?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.12 Tub or Shower

 

 

 

 

 

 

 

 

 

 

 

 

Is there a working tub or shower with hot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and cold running water?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 4

Form 89 – HQS Inspection Form

4.All Other Rooms Used for Living For each numbered item, check only one box per questions

4.1 Room Location

 

 

 

 

 

 

 

Room Code

 

_______________________

 

 

 

 

 

 

 

 

 

 

 

_

____

right/left/center:

the room is situated to the right,

1=Bedroom or any other room used for sleeping (regardless of room

 

 

 

 

 

left, or center of home

 

 

2=Dining Room or Dining Area

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

_____

front/rear/center: the room is situated to the back,

4=Entrance Halls, Corridors, Halls, Staircases

 

 

 

 

 

front, or center of home

 

5=Additional Bathroom (also check presence of sink trap and clogged toilet)

 

 

 

 

 

 

 

6=Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

_____

floor level:

the floor level on which the room

 

 

 

_______________________________________________

 

 

 

 

is located

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

 

 

Fail

 

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

 

 

Final

 

 

 

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2 Electricity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is a 1, are there at least two

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

working outlets or one working outlet and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

one working light fixture or a switched outlet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

receptacle?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is not 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 from the outside lockable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.5 Window Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If room is a 1, is there at least one window?

 

 

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

Regardless of room code, are all windows

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

free of signs of severe deterioration or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

missing or broken 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 the deteriorated surfaces exceed 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

square feet of entire room or more than 10%

 

 

 

 

 

 

 

 

 

 

Not Applicable

 

of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

 

10/20/06

Page 5

Form 89 – HQS Inspection Form

4.All Other Rooms Used for Living For each numbered item, check only one box per questions

 

4.1 Room Location

 

 

 

 

 

 

Room Code

 

______________________

 

 

 

 

 

 

 

 

 

 

_____

right/left/center:

the room is situated to the right,

1=Bedroom or any other room used for sleeping (regardless of room

 

 

 

 

 

left, or center of home

 

2=Dining Room or Dining Area

 

 

 

 

 

 

 

 

 

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

 

 

_____

front/rear/center: the room is situated to the back,

4=Entrance Halls, Corridors, Halls, Staircases

 

 

 

 

 

front, or center of home

 

5=Additional Bathroom (also check presence of sink trap and clogged toilet)

 

 

 

 

 

 

 

6=Other (specify):

 

 

 

_____

floor level:

the floor level on which the room

 

 

 

_______________________________________________

 

 

 

 

is located

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

 

 

Fail

 

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

 

 

 

Final

 

 

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2 Electricity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is a 1, are there at least two

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

working outlets or one working outlet and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

one working light fixture or a switched outlet

 

 

 

 

 

 

 

 

 

 

 

 

 

receptacle?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is not 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 from the outside lockable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.5 Window Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

If room is a 1, is there at least one window?

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

 

 

Regardless of room code, are all windows

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

free of signs of severe deterioration or

 

 

 

 

 

 

 

 

 

 

 

 

 

missing or broken 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 the deteriorated surfaces exceed 2

 

 

 

 

 

 

 

 

 

 

 

 

 

square feet of entire room or more than 10%

 

 

 

 

 

 

 

 

Not Applicable

 

 

of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 6

Form 89 – HQS Inspection Form

4.All Other Rooms Used for Living For each numbered item, check only one box per questions

 

4.1 Room Location

 

 

 

 

 

 

Room Code

 

 

______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____

right/left/center:

the room is situated to the right,

1=Bedroom or any other room used for sleeping (regardless of room

 

 

 

 

 

left, or center of home

 

2=Dining Room or Dining Area

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

_____

front/rear/center: the room is situated to the back,

4=Entrance Halls, Corridors, Halls, Staircases

 

 

 

 

 

front, or center of home

 

5=Additional Bathroom (also check presence of sink trap and clogged toilet)

 

 

 

 

 

 

 

6=Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____

floor level:

the floor level on which the room

 

 

 

_______________________________________________

 

 

 

 

is located

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

 

 

Fail

 

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

 

 

 

Final

 

 

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2 Electricity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is a 1, are there at least two

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

working outlets or one working outlet and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

one working light fixture or a switched outlet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

receptacle?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Room Code is not 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 from the outside lockable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.5 Window Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If room is a 1, is there at least one window?

 

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

Regardless of room code, are all windows

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

free of signs of severe deterioration or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

missing or broken 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 the deteriorated surfaces exceed 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

square feet of entire room or more than 10%

 

 

 

 

 

 

 

 

 

Not Applicable

 

 

of a component of the interior room?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 7

Form 89 – HQS Inspection Form

5.All Secondary Rooms Not Used for Living For each numbered item, check only one box per questions

Item No. Description

 

Pass

 

Fail

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

Final

 

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

Is the room free from electrical hazards?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.4

Other Potentially Hazardous Items

 

 

 

 

 

 

 

 

Are all of these rooms free of any other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

potentially hazardous items? For each room

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

with an “other hazardous item”, explain the

 

 

 

 

 

 

 

 

hazard and means of control of interior

 

 

 

 

 

 

 

 

access to the room.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Building Exterior

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

Fail

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

Final

 

 

 

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

 

 

6.1

Condition of Foundation

 

 

 

 

 

 

 

 

Is the foundation sound and free from

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hazards?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.2

Condition of Stairs, Rails, and

 

 

 

 

 

 

 

 

 

Porches

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are all exterior stairs, rails, and porches

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sound and free from hazard?

 

 

 

 

 

 

 

 

6.3

Condition of Roofs and Gutters

 

 

 

 

 

 

 

 

Are the roof, gutters, and downspouts sound

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and free from hazards?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.4Condition of Exterior Surfaces Are exterior surfaces sound and free from hazards?

6.5Condition of Chimney

Is the chimney sound and free from hazards?

6.6 Lead-Based Paint

 

 

 

 

 

 

 

Are all painted surfaces free of deteriorated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

paint?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If no, does the deteriorated surface exceed

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

20 square feet of entire exterior surface or

 

 

 

 

 

 

 

more than 10% of a component of the

 

 

 

 

 

 

 

exterior surface?

 

 

 

 

 

 

 

6.6 Manufactured Home

 

 

 

 

 

 

 

Is manufactured home on a permanent

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

foundation?

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 8

Form 89 – HQS Inspection Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Heating and Plumbing

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

 

Fail

 

If Fail, what repairs are necessary?

If Fail, Date of

 

 

 

Final

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

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 home free from unvented fuel burning

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

space heaters or any other types of unsafe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

heating conditions?

 

 

 

 

 

 

 

 

7.3 Ventilation and Adequacy of

 

 

 

 

 

 

 

 

Cooling **

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does the home have adequate ventilation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and cooling by means of openable windows

 

 

 

 

 

 

 

 

or a working cooling system?

 

 

 

 

 

 

 

 

7.4 Water Heater

 

 

 

 

 

 

 

 

Is the water heater located, equipped, and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

installed in a safe manner?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.5 Water Supply

 

 

 

 

 

 

 

 

Is the home served by an approvable public

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or private sanitary water supply?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.6 Plumbing

 

 

 

 

 

 

 

 

Is plumbing free from major leaks or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

corrosion that causes serious and persistent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

levels of rust or contamination of the

 

 

 

 

 

 

 

 

drinking water?

 

 

 

 

 

 

 

 

7.7 Sewer Connection

 

 

 

 

 

 

 

 

Is plumbing connected to an approvable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

public or private disposal system, and is it

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

free from sewer backup?

 

 

 

 

 

 

 

 

7.1Adequancy of Heating Equpment**

7.2Safety of Heating Equipment**

7.3Ventilation and Adequacy of Cooling**

HQS regulation, at CFR 982.401(a)(4)(ii)(B), allows for variations on acceptability criteria due to local climatic and geographic conditions. It is not generally feasible to adequately test a heating system in the summer or a cooling system in the winter. Therefore do not “fail” the home due to noncompliance with HQS at the time of inspection. If the home is equipped w/ both heating and A/C, one of them must be tested at the time of the inspection, dependent on the time of year. Require a seller certification at closing that the other system was in working order.

Additional Comments (give item number)

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 9

Form 89 – HQS Inspection Form

8. General Health and Safety

 

 

For each numbered item, check only one box per questions

 

 

 

 

 

 

 

 

 

 

 

 

Item No. Description

 

Pass

 

 

Fail

 

 

If Fail, what repairs are necessary?

If Fail, Date

 

 

 

 

 

of Final

 

 

 

 

 

 

 

 

If Pass with comments, give details.

 

 

 

 

 

 

 

 

Approval.

 

 

 

 

 

 

 

 

 

 

8.1 Access to Unit

 

 

 

 

 

 

 

 

 

 

Can home be entered without having to go

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

through another home?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.2 Exits

 

 

 

 

 

 

 

 

 

 

Is there an acceptable fire exit from this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

home that is not blocked?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.3 Evidence of Infestation

 

 

 

 

 

 

 

 

 

 

Is the home free from rats or severe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

infestation by mice or vermin?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the home free from termite infestation?

 

 

 

 

 

 

 

 

 

 

8.4 Garbage and Debris

 

 

 

 

 

 

 

 

 

 

Is the home free from heavy accumulation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of garbage or debris inside and outside?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.5 Interior Stairs

 

 

 

 

 

 

 

 

 

 

Are interior stairs free from hazards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

because of loose, broken, or missing steps;

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

absent or insecure railings; inadequate

 

 

 

 

 

 

 

 

 

 

lighting; or other hazards?

 

 

 

 

 

 

 

 

 

 

8.6 Other Interior Hazards

 

 

 

 

 

 

 

 

 

 

Is the interior of the home free from any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

other hazard not specifically identified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

previously?

 

 

 

 

 

 

 

 

 

 

8.7 Interior Air Quality

 

 

 

 

 

 

 

 

 

 

Is the home free from abnormally high

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

levels of air pollution from vehicular

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

exhaust, sewer gas, fuel gas, dust, or other

 

 

 

 

 

 

 

 

 

 

pollutants?

 

 

 

 

 

 

 

 

 

 

8.8 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?

 

 

 

 

 

 

 

 

 

 

8.9 Smoke Detectors

 

 

 

 

 

 

 

 

 

 

Is there a working smoke detector on each

 

 

 

 

 

 

 

 

 

 

level?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.9 Lead-Based Paint: Owner

 

 

 

 

 

 

 

 

 

 

Certification

 

 

 

 

 

 

 

 

Not Applicable

 

 

 

 

 

 

 

 

 

 

If owner of home is required to correct any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

deteriorated paint or lead-based paint

 

 

 

 

 

 

 

 

 

 

hazards, has the Lead-Based Paint Owner’s

 

 

 

 

 

 

 

 

 

 

Certification been completed and received?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments (give item number)

 

 

 

 

 

 

 

 

If additional space is needed for comments, go to Inspection Summary page at the end of the form.

10/20/06

Page 10

Form 89 – HQS Inspection Form

Inspection Summary for Additional Comments

Item No. Description

Continued Comments: Reason for Fail or Pass with Comments

10/20/06

Page 11

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4. Filling in If Fail Date of Final Approval, Property Address Living Room For, Pass Fail, If Fail what repairs are necessary, Living Room Present Is there a, Electricity Are there at least, and Security Are all windows and is key in this next section - be sure to take the time and be attentive with each blank!

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