Pre-Tenancy Inspection Form
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1
2Sarah Merrick
JOANNE M. MAHONEY
COMMISSIONER
COUNTY EXECUTIVE
ONONDAGA COUNTY DEPARTMENT OF SOCIAL SERVICES-ECONOMIC SECURITY
Temporary Assistance Division 421 Montgomery Street Syracuse, NY 13202
*Phone (315) 435-2700
* Fax ( 315) 435-2929 * Fax ( 315) 435-8230
PRE-TENANCY INSPECTION FORM
In an effort to prevent fraudulent activity, OCDSS-ES reserves the right to re-inspect any dwelling prior to Security Agreement authorization.
Tenant/Client Name: _________________________________ Tenant/Client Phone: _____________________________
Landlord Name: _____________________________________ Landlord Phone: _________________________________
Dwelling Address: ___________________________________________________________________________________
STREET
CITY/TOWN
ZIP CODE
Date of Inspection: _________________ Anticipated Move-In Date: __________ Anticipated Monthly Rent: _________
Inspection conducted by:
Landlord & Tenant
Landlord Only
Total number of apartments at this property ? _______________
Has a cash security deposit been received from, or paid on behalf of, the above tenant/client?
Yes
No
At inspection, were the utilities on?
Yes
No
Were smoke and carbon monoxide detectors operational?
Yes
No
Is there a working stove ?
Yes
No
Is there a working refrigerator ?
Yes
No
Directions: Circle the corresponding letter (G=Good, F= Fair, P=Poor, N= Not applicable/ Not accessible by tenant/client household) to
describe the present condition of the items listed below. See the reverse side of this document for guidance on determining condition.
Use
the Comments section to provide a detailed description of all items marked Poor, as well as any information not otherwise captured by the letter system. NOTE:
Future claims will not be paid for damage to any items classified as Poor (with no details provided) or Not applicable.
Summary of Dwelling Condition
General Condition of Unit
Good
Fair
Poor
Level of Cleanliness
Good
Fair
Poor
COMMENTS:
DOCUMENT IS NOT VALID UNLESS REQUIRED SIGNATURES ARE PRESENT AND BOXES CHECKED
Client/ Tenant signature is missing
because_____________________________________________________________________________________________
___________________________________________________________________________________________________
I have read the Notice to Tenant/Client attached to this form
and agree to the terms.
________________________________________________________
_____________________________________________________
Client/Tenant’s Signature
Date
I have read the Notice to Landlord attached to this form and
agree to the terms.
Landlord’s Vendor ID # __________________________
_____________________________________________________
Landlord/Agent’s Signature
Date
IM 5357 FRONT
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