Housing Conditions Checklist: Complete this form in duplicate as soon as you move in. Fill out, date, sign this document and keep a copy and give a copy to the landlord.

Address: ______________________ Apt. #____

Landlord_______________________________

Tenants________________________________

KEY: G-Good, F-Fair, P-Poor, D-Damaged, M-Missing

AREA	G	F	P	D	M	COMMENTS
Living Room
Floor
Walls
Ceiling
Doors
Windows
Screens
Carpet
Curtains
Lights
Blinds
Outlets
Dining Room
Floor
Walls
Ceiling
Doors
Windows
Screens
Carpet
Curtains
Lights
Blinds
Outlets
Hallway
Walls
Floor
Ceiling
Windows
Screens
Blinds
Closets
Stairs
Outlets
Kitchen
Floor
Walls
Ceiling
Doors
Windows
Screens
Carpet
Curtains
Lights
Blinds
Outlets
Refrigerator
Stove
Burners
Exhaust Fan
Cabinets
Sink
Counters

KEY: G-Good, F-Fair, P-Poor, D-Damaged, M-Missing

AREA	G	F	P	D	M	COMMENTS
Bedrooms (each one)
Floor
Walls
Ceiling
Doors
Windows
Screens
Carpet
Curtains
Lights
Blinds
Outlets
Bathrooms
Floor
Walls
Ceiling
Bathtub
Sink
Toilet
Mirror
Lights
Curtains
Towel Racks
Cabinets
Door
Window
Screen
Blinds
Outlets
Entrance
Screen Door
Door
Lock
Keys
Lights
Mailbox

Misc. Items: Air conditioning, Heating Unit, Fire Place, Closets, Drawers in Kitchen and Bathrooms, Insects, Rodents, Holes, Light Bulbs, and Paint. Other Observations: ___________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

_________________________ _________________________ ________________________

Signature of Landlord Signature of Tenant Signature of Tenant

________________________ ________________________ Signature of Tenant Signature of Tenant

_________________________ ________________________

Date Date