Housing Choice Voucher Program Inspection Checklist (Omb Approval No. 2577-0169) Page 4
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8R o o m
L o c a t i o n
4. Other Rooms Used For Living and Halls
Yes
Item
No
In-
Final Approval
Pass
No.
Fail
Conc.
Date (mm/dd/yyyy)
Comment
4.1
Room Code *
(Circle One)
(Circle One)
Right/Center/Left
Front/Center/Rear
and Room Location
____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
Not Applicable
Lead-Based Paint
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
Not Applicable
Lead-Based Paint
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
5. All Secondary Rooms
(Rooms not used for living)
5.1
None
Go to Part 6
5.2
Security
5.3
Electrical Hazards
5.4
Other Potentially Hazardous
Features in these Rooms
Page 4 of 8
Previous editions are obsolete
form HUD-52580 (3/2001)
ref Handbook 7420.8
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