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.

Comments continued on a separate page Yes

Previous editions are obsolete

No

Page 6 of 19

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

3.Bathroom

3.1 Bathroom Present

Most units have easily identifiable bathrooms (i.e., a separate room with toilet, washbasin and t ub or shower). In some cases, however, you will encounter units with scattered bathroom facilities (i.e., toilet. washbasin and tub or shower located in separate parts of the unit). At a minimum, there m ust be an enclosure ar ound t he t oilet. I n t his c ase, count t he enclosure around the toilet as the bathroom and proceed with 3.2-3.9 below, with respect to this enclosure. If there is more than one bathroom that is normally used, rate the one that is in best condition for Part 3. If there is a second bathroom that is also used, complete Part 4 of the checklist for this room. (See Inspection Manual for additional notes on rating the second bathroom.)

3.2 - 3.9 Explanation for these items is the same as that provided for “Living Room’’ with the following modifications:

3.2 Electricity

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

3.3 Electrical Hazards

Note: In addition to the previously mentioned hazards, outlets that are located where water might splash or collect are considered an electrical hazard.

3.5 Window Condition

Note: The absence of a w indow does not fail this item in the bathroom (see item 3.13, Ventilation, for relevance of window with respect to ventilation). If there is no window, but a working vent system is present, check “Pass.”

3.7 Wall Condition

Note: Include under nonhazardous defects (that would pass,

but should be noted) the following: broken or loose tile; deteriorated gr outing at t ub/wall an d t ub/floor joints, or tiled surfaces; water stains.

3.8 Floor Condition

Note: Include under nonhazardous defects (that would pass, but

should be noted) the following: missing floor tiles; water stains.

3.10 Flush Toilet in Enclosed Room in Unit

The toilet must be contained within the unit, be in proper operating condition, and be available for the exclusive use of the occupants of the u nit ( i.e., outhouses or facilities shared by oc cupants o f ot her units are not acceptable). It must allow for privacy.

Not working means: the toilet is not connected to a water supply; it is not connected to a sewer drain; it is clogged; it does not have a trap; the connections, vents or traps ar e faulty to the extent that severe leakage of w ater or escape of gases occurs; the flushing mechanism does not function properly. If the water to the unit has been t urned off, check " Inconclusive.’’ O btain ver ification f rom ow ner or m anager t hat facility works properly when water is turned on.

Comment to the right of the form if the toilet is “present, exclusive, and working,” but has the following types of defects: constant running; chipped or broken porcelain; slow draining.

If dr ain b lockage i s more s erious and occurs f urther in t he s ewer line, causing backup, check item 7.6, “Fail,” under the plumbing and heating part of t he c hecklist. A s ign o f serious s ewer bl ockage is the presence of numerous backed-up drains.

3.11 Fixed Wash Basin or Lavatory in Unit

The wash basin must be permanently installed ( i.e., a portable wash basin does not satisfy the requirement). Also, a kitchen sink used to pass the requirements under Part 2 of the checklist (kitchen facilities) cannot also serve as the bathroom wash basin. The wash basin may be located separate from the other bathroom facilities (e.g., in a hallway).

Not working means: t he wash basin is not connected t o a system that will deliver hot and cold running water; it is not connected to a properly operating drain; the connectors ( or vents or traps) are faulty to the extent that severe leakage of water or escape of sewer gases occurs. If the water to the unit or the hot water unit has been turned off, check "Inconclusive." Obtain verification from owner or manager that the system is in working condition.

Comment to the right of the form if the wash basin is “present and working,” but has the following types of minor defects: insufficient water pressure; dripping faucets; minor leaks; cracked or chipped porcelain; slow drain (see discussion above under 3.10).

3.12 Tub or Shower in Unit

Not present means that neither a tub nor shower is present in the unit. Again, these facilities need not be in the same room with the rest of the bathroom facilities. They must, however, be private.

Not working covers the same requirements detailed above for wash basin (3.11).

Comment to the right of the form if the tub or shower is present and working, but has the following types of defects: dripping faucet; minor leaks; cracked porcelain; slow drain (see discussion under 3.10); absent or broken support rod for shower curtain.

3.13 Ventilation

Working vent systems include: ventilation shafts ( non -mechanical vents) and electric fans. Electric vent fans must function when switch is turned on. (Make sure that any malfunctions are not due to the fan not being plugged in.) If electric current to the unit has not been t urned on (and there is no operable window), check “Inconclusive.” Obtain verification from owner or m anager that system works. Note: exhaust vents must be vented to the outside, attic, or crawlspace.

Comments continued on a separate page Yes

No

4.Other Room Used for Living and Halls

Complete an “ Other Room” checklist for as many “ other rooms used for living” as are present in the unit and not already noted in Parts l, 2, and 3 of the checklist. See the discussion below f or definition of ‘’used for living.’’ Also complete an ‘’Other Room” checklist for al l entrance halls, corridors, and staircases that are located within the unit and are part of the area used for living. If a hall, entry and/ or stairway ar e contiguous, rate them as a w hole (i.e., as part of one space).

Additional forms for rating “Other Rooms” are provided in the check-list.

Definition of “used for living." Rooms "used for living” are areas of the unit that are walked through or lived in on a regular basis. Do not i nclude rooms or o ther areas t hat h ave bee n permanently, or near permanently, closed off or areas that are infrequently entered. For example, do not include a utility room, attached shed, attached closed-in porch, basement, or garage if they are closed off from the main living area or ar e i nfrequently ent ered. Do include any of these areas if they are frequently used (e.g., a finished basement/play-room, a closed-in porch that is used as a bedroom during summer months). Occasional use of a washer or dryer in an otherwise unused room does not constitute regular use.

If t he uni t i s v acant and y ou do not know t he eventual use of a particular room, complete an ‘’Other Room’’ checklist if there is any chance that the room will be used on a regular basis. If there is no chance that the room will be used on a regular basis, do not include it (e.g., an unfinished basement) since it will be checked under Part 5, All Secondary Rooms (Rooms not used for living).

4.1 Room Code and Room Location Enter the appropriate room code given below: Room Codes:

1 B=edroom or a ny other r oom us ed f or sleeping ( regardless of type of room)

2= Dining Room or Dining Area

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

4= Entrance Halls, Corridors, Halls, Staircases

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

6 = Other

Room Location: Write on the line provided the location of the room with respect to the unit’s width, length and floor level as if you were standing outside the unit facing the entrance to the unit: right/left/center: record whether the room is situated to the right, left, or center of the unit.

front/rear/center: record whether the room is situated to the back, front or center of the unit.

floor level: identify the floor level on which the room is located.

If t he unit is vacant, you may hav e some difficulty pr edicting t he eventual use of a room. Before giving any room a code of 1 (bedroom), the room must meet all of the requirements for a ‘’room used for sleeping’’ (see items 4. 2 and 4.5).

4.2- 4.9 E xplanations o f t hese items are the same a s those provided for "Living Room" with the following modifications:

4.2Electricity/Illumination

If the room code is not a "1," the room must have a means of natural or ar tificial illumination such as a permanent l ight fixture, wall outlet present, or light from a window in the room or near the room. If any required item is missing, check “Fail." If the electricity is turned off, check “Inconclusive."

4.5 Window Condition

Any room used for sleeping must have at least one window. If the windows in sleeping rooms are designed to be opened, at least one window must be operable. The minimum standards do not require a window in “other rooms.” Therefore, if there is no w indow i n ano ther r oom not us ed f or s leeping, c heck “Pass,” and note “no window” in the area for comments.

4.6 Smoke Detectors

At least one battery-operated or hard-wired smoke detector must be present and working on each level of the unit, including the basement, but not the crawl spaces and unfinished attic.

Smoke detectors must be installed in accordance with and m eet the requirements of the National Fire Protection Association Standard (NFPA) 74 (or its successor standards).

If the dwelling unit is occupied by any hearing-impaired per - son, smoke detectors must have an alarm system designed for hearing-impaired per sons as specified in NFPA 74 ( or successor standards).

If t he unit was under H AP contract prior t o April 2 4, 1 993, owners who installed battery -operated or hard-wired smoke detectors in compliance with HUD’s smoke detector requirements, including the regulations published on July 30, 1992 ( 57 F R 33846), will not be required subsequently t o comply with any additional requirements mandated by NFPA 74 ( i.e. t he ow ner w ould not be required to install a s moke detector in a basement not used for living purposes, nor would the ow ner be required t o change the location of the smoke detectors that have already been installed on the other floors of the unit). In this case, check “Pass” and note under comments.

Additional Notes

For staircases, the adequacy of light and condition of the stair rails and railings is covered under Part 8 of the checklist (General Health and Safety)

4.1Room Location

______	right/left/center:	the room is situated to the right, left,
		or center of the unit.
______	front/rear/center: the room is situated to the back, front
		or center of the unit.
______	floor level:	the floor level on which the room is
		located.

Room Code

1= Bedroom or Any Other Room Used for Sleeping (regardless of type of room)

2= Dining Room or Dining Area

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

4 = Entrance Halls, Corridors, Halls, Staircases

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

6 = Other:

Comments continued on a separate page Yes

No

4.1Room Location

______	right/left/center:	the room is situated to the right, left,
		or center of the unit.
______	front/rear/center: the room is situated to the back, front
		or center of the unit.
______	floor level:	the floor level on which the room is
		located.

Room Code

1= Bedroom or Any Other Room Used for Sleeping (regardless of type of room)

2= Dining Room or Dining Area

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

4 = Entrance Halls, Corridors, Halls, Staircases

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

6 = Other:

		DECISION
		P,YESASS	F,NAILO	INCONCLUSIVE
Item	Description
No.					If Fail, what repairs are necessary?
					If Inconclusive, give details.
					If Pass with comments, give details.

4.2 Electricity/Illumination

If Room Code is a 1, are there at least two working outlets or one working outlet and one working, permanently installed light fixture?

If Room Code is not a 1, is there a means of illumination?

4.3Electrical Hazards

Is the room free from electrical hazards?

4.4Security

Are all windows and doors that are accessible from the outside lockable?

4.5Window Condition

If Room Code is a 1, is there at least one window?

And, regardless of Room Code, are all windows free of s igns of severe d eterioration or m issing or broken-out panes?

4.6Ceiling Condition

Is the ceiling sound and free from hazardous defects?

4.7Wall Condition

Are the walls sound and free from hazardous defects?

4.8Floor 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 deteriorated surfaces exceed two square	Not Applicable
	feet and/or more than 10% of a component?
	4.10 Smoke Detectors
	Is there a working smoke detector on each level?
	Do the smoke detectors meet the requirements of
	NFPA 74?
	In units occupied by the hearing impaired, is there an
	alarm system connected to the smoke detector?

Additional Comments: (Give Item Number)(Use an additional page if necessary)

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

of final approval

Comments continued on a separate page Yes

No

4.1Room Location

______	right/left/center:	the room is situated to the right, left,
		or center of the unit.
______	front/rear/center: the room is situated to the back, front
		or center of the unit.
______	floor level:	the floor level on which the room is
		located.

Room Code

1= Bedroom or Any Other Room Used for Sleeping (regardless of type of room)

2= Dining Room or Dining Area

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

4 = Entrance Halls, Corridors, Halls, Staircases

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

6 = Other:

		DECISION
		P,YESASS	F,NAILO	INCONCLUSIVE
Item	Description
No.					If Fail, what repairs are necessary?
					If Inconclusive, give details.
					If Pass with comments, give details.

4.2 Electricity/Illumination

If Room Code is a 1, are there at least two working outlets or one working outlet and one working, permanently installed light fixture?

If Room Code is not a 1, is there a means of illumination?

4.3Electrical Hazards

Is the room free from electrical hazards?

4.4Security

Are all windows and doors that are accessible from the outside lockable?

4.5Window Condition

If Room Code is a 1, is there at least one window?

And, regardless of Room Code, are all windows free of s igns of severe d eterioration or m issing or broken-out panes?

4.6Ceiling Condition

Is the ceiling sound and free from hazardous defects?

4.7Wall Condition

Are the walls sound and free from hazardous defects?

4.8Floor 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 deteriorated surfaces exceed two square	Not Applicable
	feet and/or more than 10% of a component?
	4.10 Smoke Detectors
	Is there a working smoke detector on each level?
	Do the smoke detectors meet the requirements of
	NFPA 74?
	In units occupied by the hearing impaired, is there an
	alarm system connected to the smoke detector?

Additional Comments: (Give Item Number)(Use an additional page if necessary)

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

of final approval

Comments continued on a separate page Yes

No

4.1Room Location

______	right/left/center:	the room is situated to the right, left,
		or center of the unit.
______	front/rear/center: the room is situated to the back, front
		or center of the unit.
______	floor level:	the floor level on which the room is
		located.

Room Code

1= Bedroom or Any Other Room Used for Sleeping (regardless of type of room)

2= Dining Room or Dining Area

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

4 = Entrance Halls, Corridors, Halls, Staircases

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

6 = Other:

		Decision
		PassYes,	FailNo,	Inconclusive
Item	Description
No.					If Fail, what repairs are necessary?
					If Inconclusive, give details.
					If Pass with comments, give details.

4.2 Electricity/Illumination

If Room Code is a 1, are there at least two working outlets or one working outlet and one working, permanently installed light fixture?

If Room Code is not a 1, is there a means of illumination?

4.3Electrical Hazards

Is the room free from electrical hazards?

4.4Security

Are all windows and doors that are accessible from the outside lockable?

4.5Window Condition

If Room Code is a 1, is there at least one window?

And, regardless of Room Code, are all windows free of s igns of severe d eterioration or m issing or broken-out panes?

4.6Ceiling Condition

Is the ceiling sound and free from hazardous defects?

4.7Wall Condition

Are the walls sound and free from hazardous defects?

4.8Floor 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 deteriorated surfaces exceed two square	Not Applicable
	feet and/or more than 10% of a component?
	4.10 Smoke Detectors
	Is there a working smoke detector on each level?
	Do the smoke detectors meet the requirements of
	NFPA 74?
	In units occupied by the hearing impaired, is there an
	alarm system connected to the smoke detector?

Additional Comments: (Give Item Number)(Use an additional page if necessary)

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

of final approval

Comments continued on a separate page Yes

No

5.All Secondary Rooms (Rooms not used for living)

5. Secondary Rooms (Rooms not used for living)

If any room in the unit did not meet the requirements for “other room used for living" in Part 4, it is to be considered a “secondary room (not used for living),” Rate all of these rooms together (i.e., a single Part 5 checklist for all secondary rooms in the unit).

Inspection i s r equired o f t he following t wo i tems s ince hazardous defects under these items could jeopardize the rest of the unit, even if present in rooms not used for living: 5. 2 S ecurity, 5. 3 Electrical Hazards. Also, be observant of any other potentially hazardous features in these rooms and record under 5.4

5.1 None

If there are no “Secondary Rooms (rooms not used for living),” check "None" and go on to Part 6.

5.2- 5.4 Explanations of these items is the same as those provided for ‘’Living Room’’

Additional Note

In recording “other potentially hazardous features,” note ( in the space provided) the means of access to the room with the hazard and check t he box under ‘ ’Inconclusive.” D iscuss t he haz ard with the HA inspection supervisor to determine ‘’Pass’’ or ‘’Fail.’’ Include defects like: large holes in floor, walls or ceilings; evidence of structural collapse; windows in condition o f severe deterioration; and deteriorated paint surfaces.

6.Building Exterior

6.1Condition of Foundation

‘’Unsound or hazardous’’ means foundations with severe structural defects indicating the potential for structural collapse; or foundations that allow significant entry of ground water (for example, evidenced by flooding of basement).

6.2 Condition of Stairs, Rails, and Porches

"Unsound or hazardous" means: stairs, porches, balconies, or decks w ith s evere structural defects; broken, rotting, or missing steps; ab sence of a han drail when t here are extended lengths o f steps ( generally four or more consecutive s teps); absence of or insecure railings around a porch or balcony which is approximately 30 inches or more above the ground.

6.3 Condition of Roof and Gutters

“Unsound and hazardous” m eans: The roof has s erious def ects such as serious buckling or sagging, i ndicating the pot ential of structural collapse; large holes or other defects that would result in significant a ir or water i nfiltration ( in most cases s evere exterior defects will be reflected in equally serious surface defects within the unit, e. g., b uckling, w ater d amage). T he g utters, d ownspouts and soffits ( area under tee eaves) shows serious decay and have allowed the entry of significant air or water into the interior of the structure. Gutters an d dow nspouts ar e, how ever, not required to pass. If the roof is not observable and there is no sign of interior water damage, check “Pass.”

6.4 Condition of Exterior Surfaces

See definition above for roof, item 6.3.

6.5 Condition of Chimney

The chimney should not be seriously leaning or showing evidence of significant disintegration (i.e., many missing bricks).

6.6Lead-Based Paint: Exterior Surfaces

Housing Choice Voucher Units If the unit was built January 1, 1978 or after, no child under age six will occupy or currently occupies, 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), check NA and do not inspect painted surfaces . Visual assessment for deteriorated paint applies to all exterior painted surfaces (building components) associated with the assisted unit including windows, window sills, exterior walls, floors, porches, railings, doors, decks, stairs, play areas, garages, fences or other areas if frequented by children under age six.

All deteriorated paint surfaces more than 20 sq. ft. on exterior surfaces must be stabilized (corrected) in accordance with all safe work practice requirements. If the painted surface is less than 20 sq. ft., 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.

6.7 Manufactured Homes: Tie Downs

Manufactured homes must be placed on a site in a stable manner and be free from hazards such as sliding and wind damage. Manufactured ho mes must be s ecurely an chored by a tie dow n device which distributes and transfers the loads imposed by the unit to appropriate ground anchors so as to resist wind overturning and sliding, unless a variation has been approved by the HUD Field Office.

5.All Secondary Rooms (Rooms not used for living)

Decision

Item		PassYes,	FailNo,	Inconclusive
	Description
No.

5.1 None Go to Part 6

5.2Security

Are all windows and doors that are accessible from the outside lockable?

5.3Electrical Hazards

Are all these rooms free from electrical hazards?

5.4Other Potentially Hazardous Features Are all of these rooms free of any other potentially hazardous features? For each room with an "other potentially hazardous feature," explain the hazard and the means of control of interior access to the room.

6.0Building Exterior

6.1Condition of Foundation

Is the foundation sound and free from hazards?

6.2Condition of Stairs, Rails, and Porches Are all the exterior stairs, rails, and porches sound and free from hazards?

6.3Condition of Roof 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?

6.6Lead-Based Paint: Exterior Surfaces Are all painted surfaces free of deteriorated paint?

If no, does deteriorated surfaces exceed 20 sq. ft. of total exterior surface area?

6.7Manufactured Homes: Tie Downs

If the unit is a manufactured home, is it properly placed and tied down? If not a manufactured home, check "Not Applicable."

For each numbered item, check one box only.

	If Fail, what repairs are necessary?	If Fail or
		Inconclusive,
	If Inconclusive, give details.	date (mm/dd/yyyy)
	If Pass with comments, give details.	of final approval

Not Applicable

Not Applicable

Comments continued on a separate page Yes

No

7.Heating and Plumbing

7.1 Adequacy of Heating Equipment

“Adequate heat” means that the heating system is capable of delivering enough heat to assure a healthy environment in the unit (appropriate to the climate). The HA is responsible for defining what constitutes a healthy living environment in the area of the country in which it operates. Local codes (city or state codes) should be instructive in arriving at a r easonable local definition. For example, for heat adequacy, local codes often require that the unit’s heating facility be capable of maintaining a given temperature level during a designated time period. Portable electric room heaters or kitchen stoves or r anges with a bu ilt-in h eat un it a re not ac ceptable a s a primary s ource of heat for units located in ar eas w here c limate conditions require regular heating.

“Directly or indirectly to all rooms used for living” means:

“Directly” means that each r oom used f or living has a heat source (e.g., working radiator; working hot air register; baseboard heat)

‘’indirectly’’ means that, if there is no heat source present in the room, heat can enter the room easily from a heated adjacent r oom ( e.g a dining r oom may not hav e a r adiator, but would receive heat from the heated living room through a large open archway).

If the heating system in the unit works, but there is some question whether a room w ithout a heat source w ould receive adequate indirect heat, check “Inconclusive” and verify adequacy from tenant or owner (e.g., unheated bedroom at the end of a long hallway).

How to determine the capability of the heating system: If the unit is occupied, usually the quickest way to determine the capability of the heating system over time is to question the tenant. If the unit is not oc cupied, or the tenant has not lived in the unit during t he months when heat would be needed, check “Inclusive.” It will be necessary to question the owner on this point after the inspection has been completed and, if possible, to question other tenants (if it is a muIti-unit structure) about the adequacy of he at pr ovided. Under some circumstances, t he ade quacy of he at c an be det er- mined by a simple comparison of the size of the heating system to the area to be heated. For example, a small permanently installed space h eater in a living r oom i s pr obably i nadequate f or heat ing anything larger than a relatively small apartment.

7.2 Safety of Heating Equipment

Examples of “unvented fuel burning space heaters” are: portable kerosene units; unvented open flame portable units.

‘’Other unsafe conditions’’ include: breakage or damage to heating

system such that t here is a	potential for fire or ot her threats t o
safety; improper connection	of flues al lowing ex haust ga ses t o

enter the living area; improper installation of equipment ( e.g., proximity of f uel t ank t o h eat s ource, absence of safety d evices); indications of improper use of equipment (e.g., evidence of heavy build-up of soot, creosote, or other substance in the chimney); disintegrating equipment; combustible materials ne ar h eat s ource or flue. See Inspection Manual for a more detailed discussion of the inspection of safety aspects of the heating systems.

If you are unable to gain access to the primary heating system in the unit check ‘ ’Inconclusive." Contact the owner or manager f or

verification of safety of	the s ystem. If t he s ystem has passed a
recent local inspection,	check ‘ ’Pass.” This apppies especially t o

units in w hich he at i s pr ovided by a large s cale, c omplex central heating system that s erves multiple u nits ( e.g., a boiler in the basement of a large apa rtment bu ilding). I n most cases, a large scale he ating system for a multi-unit bui lding w ill be s ubject t o periodic safety inspections by a local public agency. Check with the owner or manager to determine the date and outcome of the last such inspection, or look for an inspection certificate posted on t he heating system.

7.3 Ventilation and Adequacy of Cooling

If the tenant is present and has occupied the unit during the summer months, inquire about the adequacy of air flow. If the tenant is not present or has not occupied the unit during the summer months, test a sample of windows to see that they open (see Inspection Manual for instruction).

“Working cooling equipment’’ includes: central (fan) ventilation system; evaporative cooling system; room or central air conditioning.

Check “ Inconclusive” if there ar e no operable w indows and it is impossible, or inappropriate, to test whether a cooling system works. Check w ith ot her tenants in the building ( in a muIti-unit structure) a nd w ith the ow ner or manager for verification of t he adequacy of ventilation and cooling.

7.4 Water Heater

"Location presents hazard’’ means that the gas or oil water heater is located in living areas or closets where safety hazards may exist (e.g., water heater located in very cluttered closet with cloth and paper items stacked against it). Gas water heaters in bedrooms or other living areas must have safety dividers or shields.

Water heaters must have a temperature- pressure relief valve and discharge line ( directed t oward t he f loor or out side o f t he living area) as a safeguard against build up of steam if the water heater malfunctions. If not, they are not properly equipped and shall fail.

To pas s, ga s or oil fired w ater heaters must be vented i nto a properly installed chimney or f lue leading outside. E lectric w ater heaters do not require venting.

If it is impossible to view the water heater, check “Inconclusive.” Obtain verification of safety of system from owner or manager. Check "Pass" if t he water he ater ha s pas sed a l ocal i nspection. This applies primarily to hot water that is supplied by a l arge scale complex water heating system that serves multiple units (e.g., water heat ing s ystem in large apar tment bu ilding). Check in the same manner described for heating system safety, item 7.2, above. 7.5 Water Supply

If the s tructure is connected t o a city or town water system, check ‘’Pass.” If the structure has a private water supply ( usually in rural areas) inquire into the nature of the supply (probably from the owner) and whether it is approvable by an appropriate public agency.

General note: If items 7.5, 7.6, or 7,7 are checked “Inconclusive,” check with owner or manager for verification of adequacy.

7.6 Plumbing

“Major l eaks” m eans t hat main w ater dr ain and feed pipes ( often located in t he ba sement) are s eriously l eaking. ( Leaks pr esent at specific facilities have already been evaluated under the checklist items for “Bathroom” and “Kitchen.”)

“Corrosion” ( causing serious and persistent levels of rust or contamination in the drinking water) can be determined by observing the color of the dr inking water at ssveral taps. B adly corroded pipes will produce noticeably brownish water. If the tenant is currently occupying the unit, he or she should be able to provide information about the persistence of this condition. (Make sure that the “rusty water” is not a temporary condition caused by city or town maintenance of main water lines.) See general note under 7.5.

7.7 Sewer Connection

If the structure is connected to the city or town sewer system, check “Pass.” If t he s tructure ha s its own pr ivate di sposal s ystem ( e.g., septic f ield), inquire i nto the nature of t he system and determine whether this type of system can meet appropriate health and safety regulations.

The following conditions constitute “evidence of sewer back up”: strong sewer gas smell in the basement or outside of unit; numerous clogged or very slow drains; marshy areas outside of unit above septic field. See general note under 7.5.

7.Heating and Plumbing

Item Description

No.

7.1Adequacy of Heating Equipment

Is the heating equipment capable of providing ad- equate heat (either directly or indirectly) to all rooms used for living?

7.2Safety of Heating Equipment

Is the unit free from unvented fuel burning space heat- ers or any other types of unsafe heating conditions?

7.3 Ventilation and Adequacy of Cooling

Does t he uni t hav e adequate ventilation and cooling by means of openable windows or a working cooling system?

7.4Water Heater

Is the water heater located, equipped, and installed in a safe manner?

7.5Water Supply

Is the unit served by an approvable public or private sanitary water supply?

7.6Plumbing

Is plumbing free from major leaks or corrosion that causes serious and persistent levels of rust or con- tamination of the drinking water?

7.7Sewer Connection

Is plumbing connected to an approvable public or private disposal system, and is it free from sewer back-up?

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.

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

of final approval

Comments continued on a separate page Yes

No

8.General Health and Safety

8.1 Access to Unit

“Through another unit” means that access to the unit Is only possible by means of passage through another dwelling unit.

8.2 Exits

“Acceptable fire exit” means that the building must have an alterna- tive means of exit that meets local or State regulations in case of fire; this could include:

An openable window if the unit is on the first floor or second floor or easily accessible to the ground.

A back door opening on to a porch with a stairway leading to the ground.

Fire escape, fire ladder, or fire stairs.

“Blocked” means that the exit is not useable due to conditions such as debris, storage, door or window nailed shut, broken lock. Important note: The HA has the final responsibility for deciding whether the t ype of e mergency exit is acceptable, although t he tenant should assist in making the decision.

8.3 Evidence of Infestation

“Presence of rats, or severe infestation by mice or vermin” (such as roaches) is evidenced by: rat holes; droppings; rat runs; numerous settings of rat poison. If the unit is occupied, ask the tenant,

8.4 Garbage and Debris

“Heavy ac cumulation” means large piles of trash and ga rbage, discarded furniture, and other debr is ( not temporarily stored awaiting removal) that might harbor rodents, This may occur inside the unit, in common areas, or outside. It usually means a l evel of accumulation beyond the capacity of an individual to pick up within an hour or two.

8.5 Refuse Disposal

“Adequate covered facilities" includes: trash cans with covers, gar- bage chutes, “dumpsters” (i.e., large scale refuse boxes with lids); trash ba gs ( if a pprovable by l ocal p ublic ag ency). “ ApprovabIe by local p ublic agency” m eans t hat t he local Health and S anitation Department ( city, t own or c ounty) ap proves t he t ype of f acility i n use. Note: During the period when the HA is setting up its inspection program, it will check with the local health and sanitation department to determine w hich t ypes of facilities ar e acceptable and include this in the inspection requirements.

If the unit is vacant and there are no adequate covered facilities present, check “ Inconclusive.” Contact the owner or manager f or verification of facilities provided when the unit is occupied.

8.6 Interior Stairs and Common Halls

‘’Loose, broken, or missing steps’’ should fail if they present a serious risk of tripping or falling.

A handrail is required on extended sections of stairs (generally four or more consecutive steps). A railing is required on unprotected heights such as around stairwells.

“Other hazards” would be conditions such as bare electrical wires and tripping hazards.

Housing Choice Voucher Units If the unit was built January 1, 1978, or after, no child under six will occupy or currently occupies it, is a 0-BR, elderly or handicapped unit with no children under 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 compo- nents) 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 compo- nent 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 stabi- lized (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.

8.7 Other Interior Hazards

Examples of other hazards might be: a broken bathroom fixture with a sharp edge in a location where it represents a hazard; a protruding nail in a doorway.

8.8 Elevators

Note: At the time the HA is setting up its inspection program, it will determine local licensing practices for elevators. lnspectors should then be aware of these practices in evaluating this item (e.g., check inspection date). If no elevator check “Not Applicable.”

8.9 Interior Air Quality

If the inspector has any questions about whether an existing poor air quality condition should be considered dangerous, he or she should check w ith the local Health and Safety Department ( city, town or county).

8.10 Site and Neighborhood Conditions

Examples of conditions that would “seriously and continuously endanger the health or safety of the residents” are:

other buildings on, or near the property, that pose serious hazards ( e.g., dilapidated shed or garage w ith potential for structural collapse),

evidence of flooding or major drainage problems,

evidence of mud slides or large land settlement or collapse, proximity to open sewage,

unprotected heights (cliffs, quarries, mines, sandpits), fire hazards,

abnormal air pollution or smoke which continues throughout the year and is determined to seriously endanger health, and continuous or excessive vibration of vehicular traffic (if the unit is occupied, ask the tenant).

8.11 Lead-Based Paint: Owner Certification

If the owner is required to correct any lead- based paint hazards at the property including deteriorated paint or other hazards identi-fied by a visual assessor, a certified lead-based paint risk asses-sor, or certified lead -based paint inspector, the PHA must obtain certification that the work has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must be received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice. Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have been met and no re-inspection by the HQS inspector is required.

Comments continued on a separate page Yes

Previous editions are obsolete

No

Page 19 of 19

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