Hud 52580 A Form – Fill Out and Use This PDF

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

Single Room Occupancy

Shared Housing

Other:(Specify)

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 the repairs noted that would be necessary to bring the unit up to the standard.

2.Inconclusive If there are no checks under the column headed “Fail”

and there are checks under the column headed “Inconclusive,” obtain 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 information is obtained, change the rating for the item and record the date of verification at the far right of the form.

3. Pass If neither ( 1) nor ( 2) above is checked, the unit passes the minimum housing quality standards. Any additional conditions described in the right hand column of the form should serve to (a) establish the precondition of the unit, (b) indicate possible additional areas to negotiate with the owner,

(c)aid in assessing the reasonableness of the rent of the unit, and ( d) aid the tenant in deciding among possible units to be rented. The tenant is

responsible	for deciding whether he or she finds these conditions
acceptable.

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 box provided.

C. How to Fill Out This Checklist

Complete the checklist on the unit to be occupied (or currently occupied) by the 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 item to 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 item is: “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 to the 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 made since the last inspection. If possible, record reason for repair (e.g., ordinary maintenance, tenant damage).

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

Decision on the Unit).

Previous editions are obsolete

1.Living Room

1.1 Living Room Present

Note: If the unit is an efficiency apartment, consider the living room present.

1.2 Electricity

In order to qualify, the outlets must be present and properly installed in the baseboard, wall or floor of the room. Do not count a single duplex receptacle as two outlets, i.e., there must be two of these in the room, or one of these plus a permanently installed ceiling or wall light fixture.

Both the outlets and/or the light must be working. Usually, a room will have sufficient lights or electrical appliances plugged into outlets t o determine workability. B e s ure light f ixture doe s not f ail just because the bulb is burned out.

Do not count any of the following items or fixtures as outlets/fixtures: Table or floor lamps (these are not permanent light fixtures); ceiling lamps plugged into socket; extension cords.

If t he electric service to t he unit h as been t emporarily turned of f check ‘’Inconclusive.’’ Contact owner or manager after inspection to verify 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 support or fixture; missing cover plates on switches or outlets; badly cracked outlets; exposed fuse box connections; overloaded circuits evidenced by frequently ‘’blown’’ fuses (ask the tenant).

Check “Inconclusive’’ if you are uncertain about severity of the problem and seek expert advice.

1. 4 Security

“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. basement and first floor); windows or doors leading onto a fire escape, porch or other outside place that can be reached from the ground.

“Lockable” means: the window or door has a properly working lock, or is nailed shut, or t he window i s not designed to be opened. A storm window lock that is working properly is acceptable. Windows that are nailed shut are acceptable only if these windows are not needed for ventilation or as an alternate exit in case of fire.

1.5Window Condition

Rate the windows in the room (including windows in doors).

“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 in the space provided on the right of the form.

If there i s only “ moderate deterioration” of the w indows the item should "Pass." "Moderate deterioration” means windows which are reasonably weather-tight, but show evidence of some aging, abuse, or lack of repair. Signs of deterioration are: minor crack in window pane; splintered sill; signs of some minor rotting in the window frame or the window itself; window panes loose because of missing window putty. Also for deteriorated and peeling paint see 1.9. If more than one window is in this condition, give details in the space provided on the right of the form.

Page 2 of 19

ref Handbook 7420.8 form HUD-52580­A (04/15)

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 large cracks or holes allow significant drafts to enter the unit. The condition includes: severe bulging or buckling; large holes; missing parts; falling or in da nger of falling loose s urface materials ( other than paper or paint).

Pass ceilings that are basically sound but haves some nonhazardous defects, including: small holes or cracks; missing or broken ceiling tiles; water stains; soiled surfaces; unpainted surfaces; peeling paint (for peeling paint see item 1.9).

1.7 Wall Condition

“Unsound or hazardous” includes: serious de fects such that t he structural safety of the building is threatened, such as severe buckling, bulging or leaning; damaged or loose structural members; large holes; air infiltration.

Pass walls that are basically sound but have some non hazardous defects, including: small or shallow holes; cracks; loose or missing parts; unpainted surfaces; peeling paint (for peeling paint see item 1.9).

1.8 Floor Condition

“Unsound or hazardous” means the presence of such serious defects that a potential exists for structural collapse or other threats to safety (e.g., st ripping) or large cracks or hol es al low substantial dr afts f rom below the floor. The condition includes: severe buckling or major movements under walking stress; damaged or missing parts.

Pass floors that are basically sound but have some nonhazardous defects, including: heavily worn or damaged floor surface (for ex-ample, scratches or gouges in surface, missing portions of tile or linoleum, previous water damage). If there is a floor covering, also note the condition, especially if badly worn or soiled. If there is a f loor covering, including paint or sealant, al so note the conditions, specially if badly worn, soiled or peeling (for peeling paint, see 1.9).

1.9Lead-Based Paint

Housing Choice Voucher Units If the unit was built January 1, 1978, or after, no child under age six will occupy or currently occupies it, is a 0-BR, elderly or handicapped unit with no children under 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 of lead-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 paint include walls, floors, ceilings, built in cabinets (sink bases), baseboards, doors, door frames, windows systems including mullions, sills, or frames and any other painted building component within the unit. Deteriorated paint includes any painted surface that is peeling, chipping, chalking, cracking, damaged or otherwise 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 surface area of an interior type of component with a small surface area (i.e., window sills, baseboards, and trim) must be stabilized (corrected) in accordance with all safe work practice requirements and clearance is required. If the deteriorated painted surface is less than 2 sq. ft. or less than 10% of the component, only stabilization is required. Clearance testing is not required. Stabilization means removal of deteriorated paint, repair of the substrate, and application of a new protective coating or paint. Lead-Based Paint Owner Certification is required following stabilization activities, except for DE MINIMIS LEVEL repairs.

1.Living Room

Item Description

No.

1.1Living Room Present Is there a living room?

1.2Electricity

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 feet and/or more than 10% of a component?

Additional Comments: (Give Item Number)

For each numbered item, check one box only.

Decision

	PassYes,		FailNo,		Inconclusive		If Fail, what repairs are necessary?
							If Inconclusive, give details.
							If Pass with comments, give details.

Not Applicable

If Fail or Inconclusive, date (mm/dd/yyyy) of final approval

Comments continued on a separate page Yes

No

2.Kitchen

2.1 Kitchen Area Present

Note: A kitchen is an area used for preparation of meals. It may be either a separate room or an area of a larger room (for example, a kitchen area in an efficiency apartment).

2.2- 2.9 Explanation for these items is the same as that provided for "Living Room’’ with the following modifications:

2.2Electricity

Note: The requirement is that at least one outlet and one permanent light fixture are present and working.

2.5 Window Condition

Note: The absence of a window does not fail this item in the kitchen. If there is no window, check “Pass.”

2.10 Stove or Range with Oven

Both an oven and a stove ( or range) w ith t op burners must be present and working. If either Is missing and you know that the owner is responsible for supplying these appliances, check “Fail.’’ Put check in ‘’Inconclusive’’ column if the tenant is responsible for supplying the appliances and he or she has not yet moved i n. Contact tenant or prospective tenant to gain verification that facility will be supplied and is in working condition. Hot plates are not acceptable substitutes for these facilities.

An oven is not working if it will not heat up. To be working a s tove or range must have all burners working and knobs to turn them off and on. Under “ working c ondition,” also look for hazardous gas hook-ups evidenced by s trong ga s smells; these s hould f ail. ( Be sure that this condition is not confused with an unlit pilot light -a condition that should be noted, but does not fail.)

If both an oven and a stove or range are present, but the gas or electricity are turned off, check “ Inconclusive.” Contact owner or manager to get v erification t hat f acility w orks w hen gas is t urned on. If both an oven and a stove or range are present and working, but d efects exist, check " Pass" and not e t hese to t he right 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 oven and stove (or range).

A microwave oven may be substituted for an owner-supplied oven and stove (or range) if the tenant agrees and microwave ovens are furnished instead of ovens and stoves (or ranges) to both subsidized and unsubsidized tenants in the building or premises.

2.11 Refrigerator

If no refrigerator is present, use the same criteria for marking either “Fail” or “Inconclusive” as were used for the oven and stove or range.

A refrigerator is not working if it will not maintain a temperature low enough to keep food from spoiling over a reasonable period of time. If t he el ectricity i s t urned of f, m ark ‘ ’Inconclusive.’’ C ontact owner (or tenant if unit is occupied) to get verification of working condition.

If the refrigerator is present and working but defects exist, note these to the right of the form. Possible minor defects include: broken or missing interior shelving; dented or scratched interior or exterior surfaces; minor deterioration of door seal; loose door handle.

2.12 Sink

If a permanently attached kitchen sink is not present in the kitchen or kitchen area, mark ‘’Fail.’’ A sink in a bathroom or a por table basin will not satisfy this requirement. A sink is not working unless it has running hot and cold water from the faucets and a properly connected and properly w orking dr ain ( with a “gas t rap”). In a vacant apar tment, t he hot w ater may have be en turned off and there w ill be no hot water. Mark this “Inconclusive.” Check with owner or manager to verify that hot water is available when service is turned on.

If a working sink has defects, note this to the right of the item. 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 space must be available for the storage, preparation, and serving of f ood. If t here i s no bui lt-in s pace f or f ood storage and preparation, a table used for food preparation and a portable storage cabinet will satisfy t he requirement. If t here is no built-in space, and no room for a table and portable cabinet, check “Inconclusive” a nd discuss with t he tenant. T he t enant makes t he final determination as to whether or not this space is acceptable.

If there are some minor defects, check "Pass" and make notes to the right. Possible def ects i nclude: marked, dented, or scratched surfaces; broken shelving or cabinet doors; broken drawers or cabinet hardware; limited size relative to family needs.