Housing Choice Voucher Program Inspection Checklist (Omb Approval No. 2577-0169) Page 3
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8No
In-
Yes
4. Other Rooms Used For Living and Halls
Final Approval
Item
No.
Pass
Fail
Conc.
Comment
Date (mm/dd/yyyy)
4 ..1
Room Code* and
(Circle One)
(Circle One)
Room Location
Right/Center/Left
Front/Center/Rear
____Floor Level
4.2
Electricity/Illumination
4.3 Electrical Hazards
4.4 Security
4.5 Window Condition
4.6 Ceiling Condition
4.7 Wall Condition
4.8 Floor Condition
4.9 Lead-Based Paint
Not Applicable
Are all painted surfaces free of deteriorated
paint?
If not, do deteriorated surfaces exceed two
square feet per room and/or is more than
10% of a component?
4.10 Smoke Detectors
4.1 Room Code* and
(Circle One)
(Circle One)
Room Location
Right/Center/Left
Front/Center/Rear
____Floor Level
4.2
Electricity/Illumination
4.3 Electrical Hazards
4.4 Security
4.5 Window Condition
4.6 Ceiling Condition
4.7 Wall Condition
4.8 Floor Condition
4.9 Lead-Based Paint
Not Applicable
Are all painted surfaces free of deteriorated
paint?
If not, do deteriorated surfaces exceed two
square feet per room and/or is more than
10% of a component?
4.10 Smoke Detectors
(Circle One)
(Circle One)
4.1 Room Code* and
Right/Center/Left
Front/Center/Rear
____Floor Level
Room Location
4.2
Electricity/Illumination
4.3 Electrical Hazards
4.4 Security
4.5 Window Condition
4.6 Ceiling Condition
4.7 Wall Condition
4.8 Floor Condition
4.9 Lead-Based Paint
Not Applicable
Are all painted surfaces free of deteriorated
paint?
If not, do deteriorated surfaces exceed two
square feet per room and/or is more than
10% of a component?
Page 3 of 8
form HUD52580 (3/2001)
Previous editions are obsolete
ref Handbook 7420.8
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