Inspection Checklist U.S. Department of Housing OMB Approval No.

2577-0169
and Urban Development (Exp. 07/31/2022)
Housing Choice Voucher Program Office of Public and Indian Housing

Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number .

Assurances of confidentiality are not provided under this collection.

This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to determine
if a unit meets the housing quality standards of the section 8 rental assistance program.

Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by
Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). Collection of the name and address of both family and the owner is mandatory. The
information is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this information
to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or
released outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of family participation.

Name of Family Tenant ID Number Date of Request (mm/dd/yyyy)

Walls N/A 12/2/1973

Inspector Neighborhood/Census Tract Date of Inspection (mm/dd/yyyy)
Synomi Hatley N/A 12/2/1973
Type of Inspection Date of Last Inspection (mm/dd/yyyy) PHA
Initial ✔ Special Reinspection
Unknown
A. General Inf ormation
Inspected Unit Year Constructed (yyyy) Housing Type (check as appropriate)
Full Address (including Street, City, County, State, Zip) Single Family Detached
Duplex or Two Family
Row House or Town House
Low Rise: 3, 4 Stories,
Including Garden Apartment
Number of Children in Family Under 6
High Rise; 5 or More Stories
Manufactured Home
Owner Congregate
Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number Cooperative
Independent Group
Residence
Address of Owner or Agent Single Room Occupancy
Shared Housing
Other

B. Summary Decision On Unit (To be completed after form has been filled out
Number of Bedrooms for Purposes Number of Sleeping Rooms
Pass
of the FMR or Payment Standard
Fail
Inconclusive
Inspection Checklist
Item Yes No In- Final Approval
No. 1. Living Room Pass Fail Conc. Comment Date (mm/dd/yyyy)

1.1 Living Room Present

1.2 Electricity

1.3 Electrical Hazards

1.4 Security
1.5 Window Condition

1.6 Ceiling Condition

1.7 Wall Condition

1.8 Floor Condition
Previous editions are obsolete Page 1 of 8 form HUD-52580 (7/2019)
* Room Codes: 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2 = Dining Room or Dining Area;
3 = Second Living Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = Other
Item 1. L ivin g Room (Continued) Yes No In- Final Approval
No. Pas Fail Conc. Comment Date (mm/dd/yyyy)
1.9 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?

2. K i t c h e n
2.1 Kitchen Area Present
2.2 Electricity

2.3 Electrical Hazards

2.4 Security

2.5 Window Condition

2.6 Ceiling Condition

2.7 Wall Condition

2.8 Floor Condition

2.9 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?
2.10 Stove or Range with Oven

2.11 Refrigerator

2.12 Sink
2.13 Space for Storage, Preparation, and Serving
of Food
3. Bathroom
3.1 Bathroom Present

3.2 Electricity

3.3 Electrical Hazards

3.4 Security
3.5 Window Condition
3.6 Ceiling Condition

3.7 Wall Condition

3.8 Floor Condition
Not Applicable
3.9 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?
3.10 Flush Toilet in Enclosed Room in Unit

3.11 Fixed Wash Basin or Lavatory in Unit

3.12 Tub or Shower in Unit

3.13 Ventilation
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form HUD­52580 (7/2019)
Item No. 4. Other Rooms Used For Living and Halls Yes No In- Final Approval
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

4.1 Room Code* and (Circle One) (Circle One)
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?

Previous editions are obsolete Page 3 of 8 form HUD­52580 (7/2019)

 Room Location

Item 4. Other Rooms Used For Living and Halls Yes No In- Final Approval
No. Pass Fail Conc. Comment Date (mm/dd/yyyy)
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 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
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

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Item 6. Building Exterior Yes No In - Final Approval
No. Pass Fail Conc. Comment Date (mm/dd/yyyy)

6.1 Condition of Foundation

6.2 Condition of Stairs, Rails, and Porches

6.3 Condition of Roof/Gutters

6.4 Condition of Exterior Surfaces

6.5 Condition of Chimney

6.6 Lead Paint: Not Applicable

Exterior Surfaces
Are all painted surfaces free of deteriorated
paint?
If not, do deteriorated surfaces exceed 20
square feet of total exterior surface area?

6.7 Manufactured Home: Tie Downs

7. Heating and Plumbing

7.1 Adequacy of Heating Equipment

7.2 Safety of Heating Equipment

7.3 Ventilation/Cooling
7.4 Water Heater

7.5 Approvable Water Supply

7.6 Plumbing

7.7 Sewer Connection

8. General Health and Safety

8.1 Access to Unit

8.2 Fire Exits

8.3 Evidence of Infestation
8.4 Garbage and Debris

8.5 Refuse Disposal

8.6 Interior Stairs and Commom Halls

8.7 Other Interior Hazards

8.8 Elevators
8.9 Interior Air Quality
8.10 Site and Neighborhood Conditions
8.11 Lead-Based Paint: Owner's Certification Not Applicable

If the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identified by a
visual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that the
work has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must be
received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice.
Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have been
met and no re-inspection by the HQS inspector is required.

Previous editions are obsolete Page 5 of 8 form HUD-52580 (7/2019)

C. Special Amenities (Optional)
This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present.
Although the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration in
decisions about renting the unit and the reasonableness of the rent.
Check/list any positive features found in relation to the unit.

D. Questions to ask the Tenant (Optional)

1. Living Room 4. Bath
High quality floors or wall coverings Special feature shower head
Working fireplace or stove Balcony, Built-in heat lamp
patio, deck, porch Special windows Large mirrors
or doors Glass door on shower/tub
Exceptional size relative to needs of family Separate dressing room
Other: (Specify) Double sink or special lavatory
Exceptional size relative to needs of family
Other: (Specify)

2. Kitchen
Dishwasher
Separate freezer
Garbage disposal
Eating counter/breakfast nook
Pantry or abundant shelving or cabinets
Double oven/self cleaning oven, microwave 5. Overall Characteristics
Double sink Storm windows and doors
High quality cabinets Other forms of weatherization (e.g., insulation, weather
Abundant counter-top space stripping) Screen doors or windows
Modern appliance(s) Good upkeep of grounds (i.e., site cleanliness, landscaping,
Exceptional size relative to needs of family condition of lawn)
Other: (Specify) Garage or parking facilities
Driveway
Large yard
Good maintenance of building exterior
Other: (Specify)

3. Other Rooms Used for Living

High quality floors or wall coverings
Working fireplace or stove Balcony,
patio, deck, porch Special windows
6. Disabled Accessibility
or doors
Exceptional size relative to needs of family Unit is accessible to a particular disability. Yes No
Other: (Specify) Disability

Previous editions are obsolete Page 6 of 8 form HUD-52580 (7/2019)

1. Does the owner make repairs when asked? Yes1R
2. How many people live there? _____
3. How much money do you pay to the owner/agent for rent? $ ____________
4. Do you pay for anything else? (specify) __________________________________________________________________
5. Who owns the range and refrigerator? (insert O = Owner or T = Tenant) Range ______ Refrigerator _____ Microwave __
6. Is there anything else you want to tell us? (specify) Yes1R
 

Previous editions are obsolete Page 7 of 8 form HUD-52580 (7/2019)

E. Inspection Summary/Comments (Optional)
Provide a summary description of each item which resulted in a rating of "Fail" or "Pass with Comments."
Tenant ID Number Inspector Date of Inspection (mm/dd/yyyy) Address of Inspected Unit

Type of Inspection Initial Special Reinspection

Item Number Reason for "Fail" or "Pass with Comments" Rating

Continued on additional page Yes No

Previous editions are obsolete Page 8 of 8 form HUD- 52580 (4/2015)

ref Handbook 7420.8