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Housing Quality & Safety Inspection Checklist
Inspection Date
Caregiver Present at Time of Inspection
Property Address
Property Type
Single Family
Apartment
Townhouse
Manufactured Home
Shared Living Arrangement
Inspection Type
Initial
Annual
Compliant
Reinspection
Living Room
HUD Requirement: Ceiling in good condition
Pass
Fail
N/A
HUD Requirement: Walls in good condition
Pass
Fail
N/A
HUD Requirement: Floors in good condition
Pass
Fail
N/A
HUD Requirement: Minimum two outlets OR one outlet and permanent light fixture
Pass
Fail
N/A
HUD Requirement: No exposed wiring or electrical hazards
Pass
Fail
N/A
HUD Requirement: Window present and operational
Pass
Fail
N/A
HUD Requirement: Window and door locks function properly
Pass
Fail
N/A
HUD Requirement: No peeling/chipping paint where applicable
Pass
Fail
N/A
FFF Recommendation: Weather stripping intact
Pass
Fail
N/A
Any comments related to the condition of the living room?
Kitchen
HUD Requirement: Ceiling in good condition
Pass
Fail
N/A
HUD Requirement: Walls in good condition
Pass
Fail
N/A
HUD Requirement: Floor in good condition
Pass
Fail
N/A
HUD Requirement: Permanent lighting present
Pass
Fail
N/A
HUD Requirement: Working electrical outlets
Pass
Fail
N/A
IRSS Requirement: GFCI outlet protection near water source
Pass
Fail
N/A
HUD Requirement: Stove and oven operational
Pass
Fail
N/A
HUD Requirement: Refrigerator operational
Pass
Fail
N/A
HUD Requirement: Sink with hot and cold water
Pass
Fail
N/A
HUD and IRSS Requirement: Adequate food storage
Pass
Fail
N/A
HUD and IRSS Requirement: Adequate food preparation area
Pass
Fail
N/A
HUD and IRSS Requirement: Adequate food serving area
Pass
Fail
N/A
Any comments related to the condition of the kitchen?
Bathroom
HUD Requirement: Flush toilet operational
Pass
Fail
N/A
HUD Requirement: Sink with hot and cold water
Pass
Fail
N/A
HUD Requirement: Tub/shower operational
Pass
Fail
N/A
HUD Requirement: Ventilation present (window or fan)
Pass
Fail
N/A
HUD Requirement: Floor in good condition
Pass
Fail
N/A
HUD Requirement: Walls in good condition
Pass
Fail
N/A
HUD Requirement: Ceiling in good condition
Pass
Fail
N/A
HUD Requirement: Permanent lighting present
Pass
Fail
N/A
IRSS Requirement: GFCI outlet protection near water source
Pass
Fail
N/A
Any comments related to the condition of the bathroom?
Bedroom and Sleeping Areas
HUD Requirement: Window present in sleeping room
Pass
Fail
N/A
HUD Requirement: Window operational and secure
Pass
Fail
N/A
HUD Requirement: Ceiling in good condition
Pass
Fail
N/A
HUD Requirement: Walls in good condition
Pass
Fail
N/A
HUD Requirement: Floors in good condition
Pass
Fail
N/A
HUD Requirement: Required electrical service
Pass
Fail
N/A
IRSS Requirement: Smoke detectors in all sleeping rooms
Pass
Fail
N/A
IRSS Requirement: Carbon monoxide detector within 15 feet
Pass
Fail
N/A
FFF Recommendation: Bedroom provides privacy and adequate space
Pass
Fail
N/A
Any comments related to the condition of the bedrooms?
Secondary Rooms/Storage Areas
HUD Requirement: No structural hazards
Pass
Fail
N/A
HUD Requirement: No exposed wiring
Pass
Fail
N/A
HUD Requirement: Safe access to room
Pass
Fail
N/A
IRSS Requirement: No tripping hazards
Pass
Fail
N/A
HUD Requirement: Stairs safe and secure
Pass
Fail
N/A
Any comments related to the condition of the secondary rooms?
Building Exterior
HUD Requirement: Foundation in good condition
Pass
Fail
N/A
HUD Requirement: Roof free from leaks
Pass
Fail
N/A
HUD Requirement: Exterior walls in good condition
Pass
Fail
N/A
HUD Requirement: Gutters functional
Pass
Fail
N/A
HUD and IRSS Requirement: Stairs and railings secure
Pass
Fail
N/A
HUD and IRSS Requirement: Decks, porches, balconies safe
Pass
Fail
N/A
HUD Requirement: Chimney free from major defects
Pass
Fail
N/A
Any comments related to the condition of the home exterior?
Heating, Plumbing and Utilities
HUD Requirement: Heating system operational
Pass
Fail
N/A
HUD Requirement: Heating system safely installed
Pass
Fail
N/A
HUD Requirement: Water heater safely installed
Pass
Fail
N/A
HUD Requirement: Plumbing functional
Pass
Fail
N/A
HUD Requirement: Safe water supply
Pass
Fail
N/A
HUD Requirement: Approved sewage disposal
Pass
Fail
N/A
HUD and IRSS Requirement: Adequate ventilation/ cooling
Pass
Fail
N/A
Any comments related to the condition of the home heating, plumbing and utilities?
Health and Safety
HUD Requirement: Smoke detector on every level
Pass
Fail
N/A
IRSS Requirement: Fire extinguisher present and accessible
Pass
Fail
N/A
HUD and IRSS Requirement: Emergency exits accessible
Pass
Fail
N/A
HUD Requirement: No infestation observed
Pass
Fail
N/A
HUD Requirement: Garbage properly stored
Pass
Fail
N/A
HUD Requirement: Interior stairs and hallways safe
Pass
Fail
N/A
HUD Requirement: Air quality acceptable
Pass
Fail
N/A
HUD Requirement: Neighborhood free of obvious hazards
Pass
Fail
N/A
Any comments related to general health and safety?
Participant-Specific Safety Review
IRSS Requirement: Home appropriate for participant needs
Pass
Fail
N/A
IRSS Requirement: Accessibility accommodations available if needed
Pass
Fail
N/A
IRSS Requirement: Participant can safely enter and exit home
Pass
Fail
N/A
IRSS Requirement: Emergency evacuation plan discussed
Pass
Fail
N/A
FFF Recommendation: Medication storage is secure
Pass
Fail
N/A
FFF Recommendation: Cleaning chemicals stored safely
Pass
Fail
N/A
FFF Recommendation: Participant-specific risks addressed
Pass
Fail
N/A
Any comments related to participant-specific safety?
Inspection Results
HUD compliance status
Pass
Fail
N/A
IRSS compliance status
Pass
Fail
N/A
Overall placement staus
Approved for placement
Approved with corrections required
Not approved
Required Corrections
Corrections Due Date
Provider Email Address
Inspector Signature
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