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Homeowner First Name
*
Homeowner Last Name
*
Date of Inspection
*
Month
Month
Day
Year
Address
*
Inspection Performed By
*
Stories
*
Bedrooms
*
Bathrooms
*
Does the furnace work?
Yes
No
Unknown
Is the gas turned on?
Yes
No
Unknown
Is the water turned on?
Yes
No
Unknown
Is the electric service connected?
Yes
No
Unknown
Is the attic insulated?
Yes
No
Unknown
Is there a smoke detector in each bedroom?
Yes
No
Unknown
Is there at least one CO2 detector?
Yes
No
Unknown
Does the main sewer line work?
Yes
No
Unknown
Is the roof free of leaks?
Yes
No
Unknown
Is there a bathroom on the first floor?
Yes
No
Unknown
Yard
Overgrown trees/bushes/shrubs/vines
Lawn needs mowing
Trash in the yard
Fence/gate repair is needed
Dumpster needed
Accessibility
Repairs needed to wheelchair ramp
Wheelchair ramp needs to be built
Sidewalk repair/replacement/addition is needed
Front Steps
Concrete
Wood
Front Steps
Minor repair needed
Major repair/replacement needed
Handrail repair/replacement/addition is needed
Back Steps
Concrete
Wood
Back Steps
Minor repair needed
Major repair/replacement needed
Handrail repair/replacement/addition is needed
Porch/Deck
Minor repair/maintenance needed
Major repair/replacement needed
Railing repair/addition is needed
Doors (Exterior)
Main/storm door needs adjustment/repair to open/close/latch properly
Damaged main/storm door needs replacement
Main/storm door sweep/weather stripping needed
Main/storm door threshold or molding repair/replacement needed
Main/storm door - replace broken/missing glass
Storm door - replace damaged/missing screen
Storm door - install storm door closer
Windows
Wood
Vinyl
Windows
Cracked/broken glass
Damaged/missing screen
Rotted wood sash/sill/molding
Window replacement is recommended
Glazing/caulking needed
Siding
Brick
Stucco
Stone
Wood
Metal
Vinyl
Siding
Minor repairs/touch up painting needed
Major repairs needed
Whole exterior needs painting
Soffit boards need repair/replacing
Facia board(s) is rotted and needs replacing
Roof/Gutters/Downspouts
Minor/moderate roof repair needed
Major roof repair needed
Minor gutter/downspout repair needed
Major gutter/downspout repair needed
Gutters need to be cleaned
Chimney repair needed
Recommend splash blocks or downspout extensions needed
Foundation Type
Basement
Crawl Space
Slab on Grade
Basement Type (If Applicable)
Stone
Cement
Cinder Block
Foundation
Walls need minor repair (mortar/crack repair)
Walls need major repair (wall caving)
Additional fill dirt or regrading needed against foundation wall
Structure
Structural (beam/joist/column) repair needed
General Interior
Minor ceiling/wall repairs/painting needed
Major ceiling/wall repairs/painting
Door needs repair/replacement
Floor Type
Wood
Carpet
Ceramic Tile
Vinyl
Laminate
Floor
Minor repairs needed
Major repairs needed
Stairs
Minor repairs needed
Major repairs needed
Handrail repair/installation is needed
Kitchen Sink
Sink faucet drips/wastes water
Low hot/cold water flow/pressure
Sink faucet needs replacement
Faucet spray doesn't work
Sink drain leaks
Sink drain is clogged
Sink/countertop needs caulking
Sink needs replacement
Kitchen Cabinets/Countertop
Cabinets need repair/replacement
Countertop needs replacement
Cabinet floor under sink needs repair/replacement
Kitchen Lights/Outlets
Kitchen light doesn't work
Kitchen outlet (receptacle) doesn't work
Recommend GFCI receptacle
Kitchen Floor
Needs repair
Stove Type
Electric
Gas
Stove
Burners don't work
Oven doesn't work
Refrigerator
Refrigerator doesn't work
Freezer doesn't work
Bathroom Door
Needs repair/adjustment or replacement
Toilet
Wastes water (bad flapper or fill valve)
Leaks or emits odor (likely a bad wax ring)
Not properly secured to the floor
Does not flush
New toilet needed
Waste pipes need replacing
Need elevated toilet seat
Need to add grab bars
Bathroom Sink
Sink faucet drips/wastes water
Low hot/cold water flow/pressure
Sink faucet needs replacement
Faucet spray doesn't work
Sink drain leaks
Sink drain is clogged
Sink/countertop needs caulking
Sink needs replacement
Sink cabinet needs repair or replacement
Tub/Shower
Tub spout/shower head drips/wastes water
Low hot/cold water flow/pressure
Tub/shower faucet doesn't work
Bad tub/shower diverter valve
Tub/shower drain leaks
Tub/shower drain is clogged
Tub needs caulking
Recommend replacing tub with shower
Recommend grab bars for safety
Bathroom Lights/Outlets
Bathroom light doesn't work
Bathroom outlet (receptacle) doesn't work
Recommend GFCI receptacle
Bathroom Floor
Needs repair
Laundry Location
Basement
Main level
Washer
Water supply line(s) leaking
Drain is clogged/backs up
Washer doesn't work
Dryer Type
Electric
Gas
Dryer
Dryer doesn't vent properly to the exterior
Dryer doesn't work
Electrical
Bad receptacle/switch/light fixture/ceiling fan needs replacement
Additional receptacle(s) needed to minimize use of extension cords
Unsafe electric panel/wiring/need correction
Replace switch or outlet cover plate(s)
Service entrance/meter defect - contact utility provider
Plumbing
Main water supply line leaks needs replacement or repair
Other water supply line(s) need repair
Main sewer line needs replacing
Sewer line backs up - needs to be cleared
Drain line leak needs repair
Water heater does not work
Heating & Cooling
Furnace does not work
A/C does not work
Air filter needs to be cleaned/replaced
Outside AC compressor fins are dirty - needs cleaning
Window A/C unit(s) needs replacing
Thermostat needs replacing
Flu pipe rusted and needs replacing
Summary
Homeowner needs help
Homeowner is deserving
Homeowner will be appreciative
This will be a safe environment for volunteers
This house should be included in the CIO program
Notes
File upload
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Hours Worked on Inspection
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