| Item | Pass | Fail | Comments |
|---|---|---|---|
| Living Room | |||
| Kitchen | |||
| Bathroom(s) | |||
| Bedroom(s) | |||
| Other Rooms & Halls |
| Criteria | Pass | Fail | Comments |
|---|---|---|---|
| Smoke Detectors Present and Working | |||
| Carbon Monoxide Detectors Present and Working | |||
| No Evidence of Pest Infestation | |||
| Handrails on Stairs/Safety Railings | |||
| Emergency Exits Unblocked | |||
| Electrical Outlets/Switches Safe | |||
| Heating System Functional | |||
| Hot/Cold Water Available | |||
| Proper Sanitation Provided | |||
| Windows Open, No Broken Panes | |||
| Doors & Locks Work Properly | |||
| Walls, Ceilings, Floors Good Condition |