Didd Home Inspection Form For Supported Living And Semi-Independent Living printable pdf download

Didd Home Inspection Form For Supported Living And Semi-Independent Living

DIDD HOME INSPECTION FORM FOR SUPPORTED LIVING and SEMI-INDEPENDENT LIVING

The checklist is used prior to anyone moving into a home or apartment. It is important all Independent

Support Coordination agencies and residential providers are aware of these items so appropriate

residences are selected for people. Some basic items that should be in place before a home or apartment

is selected or occupied are:

1. **At least one smoke detector must be operable.

2. **Lights must have globe covers including those in closets.

3. **There is a second means of exit (window or door).

4. **All outlets near a water source (i.e.: sink) must be GFCI.

5. **Handrails must be present on exterior steps and ramps.

6. **Windows made to open easily and stay open without props.

7. **A second floor bedroom can not be used for a person using an ambulation aid.

Inspection Codes:

Pass: Meets specified requirement acceptable for move in or continued occupancy.

**Fail: Does not meet specified requirement acceptable for move in or continued occupancy. The deficiency

found would impact the health of the participant and/or safety of the unit and needs correction within 30 days.

YES

**Are there any leaks in the roof or ceiling?

Are there any holes in the floor or walls?

Are there any plumbing leaks or other plumbing problems?

Are there any electrical problems?

**Are there any cracks or breaks in any of your windows?

Are there any locks on all of your windows in each room?

**Will at least one window in each room remain up when raised?

Do your oven and all 4 burners on your stove work properly?

Does your freezer or refrigerator work properly?

Do you have any bugs or mice?

Do you have a key to unlock your doors?

What kind of water do you have?

CITY

WELL

Do you have any problems with your water, such as leaks, rust or

corrosion, odors or inadequate pressure?

What kind of air conditioning do you have?

Central

None

Is your heat……?

GAS

ELECTRIC

If gas, is it…….

NATURAL

PROPANE

What kind of heat do you have?

Central

Ventless Gas

Wood

Baseboard

Radiant

Other

Are you having any problems with your heat?

YES

WHAT KIND

Do persons use a wheelchair or an ambulation aid?

YES

If so, do any consumers self-propel?

YES

If so, are all interior floors hard for easy ambulation/propelling?

If no, what rooms make it difficult to self-propel?

Revised 4/22/15

DIDD-0498

Didd Home Inspection Form For Supported Living And Semi-Independent Living

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