HQS Unit Assessment

In preparation for your upcoming virtual Housing Quality Standards (HQS) Inspection, to be conducted via video conference, please complete and submit this form to hcvpinspections@thecha.org at least 10 calendar days prior to your scheduled date of inspection.

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* 1. Print Name

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* 2. Voucher Number

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* 3. Property Address

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* 4. Children under 6 years of age reside in the unit.

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* 5. A household member is expecting.

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* 6. All outlets are working correctly.

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* 7. All light fixtures are working correctly and mounted securely to the ceiling or wall.

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* 8. All windows open and close properly.

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* 9. Water leaks are present under the sink, in the tub or anywhere else in the unit.

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* 10. Hot and cold water is adequate for use.

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* 11. The temperature in the refrigerator and freezer is adequate for food storage.

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* 12. The stove and oven are in good working condition.

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* 13. All floors are sound and free of weak spots, tripping hazards and/or other hazards.

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* 14. Penetrating holes in the walls or floors are present.

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* 15. There are suspicious odors in the household.

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* 16. My heat is working properly.

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* 17. All exit and entry doors to the unit are secure and locks are in good working order.

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* 18. Stairs and porch(es) are sound and free of any hazardous conditions.

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* 19. Exterior grounds are free of tripping hazards.

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* 20. There are hazardous conditions on exterior surfaces.

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* 21. There are mice or roaches or other infestation present.

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* 22. Tenant has access to the basement.

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* 23. Tenant has access to the garage.

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* 24. There are leaks from the ceiling or walls.

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* 25. All smoke detectors and carbon monoxide detectors are within 15 feet of sleeping rooms and boiler rooms, and in proper working condition.

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* 26. I have informed the property owner/manager of any safety hazards or concerns in my unit.

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* 27. Comments

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* 28. Signature (By typing your name, you acknowledge the above information is correct to the best of your knowledge)

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* 29. Today's Date

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