Property Assessment Form
Contact Information
Landlord's Name
First Name
Last Name
Landlord's Email
example@example.com
Landlord's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Assessment
Exterior
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Front Door
1
2
3
4
Front Screen Door
5
6
7
8
Back Door
9
10
11
12
Back Screen Door
13
14
15
16
Windows
17
18
19
20
Frames
21
22
23
24
Apartment Number
25
26
27
28
Recycling Containers
29
30
31
32
Security Intercom
33
34
35
36
Doorbell
37
38
39
40
Mail Box
41
42
43
44
Kitchen
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Sink
45
46
47
48
Floor
49
50
51
52
Walls
53
54
55
56
Lights and Switches
57
58
59
60
Windows
61
62
63
64
Refrigerator
65
66
67
68
Dishwasher
69
70
71
72
Garbage Disposal
73
74
75
76
Baseboards
77
78
79
80
Stove
81
82
83
84
Trim
85
86
87
88
Dining Room
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Floor
89
90
91
92
Walls
93
94
95
96
Lights and Switches
97
98
99
100
Windows
101
102
103
104
Curtains
105
106
107
108
Cable Outlet
109
110
111
112
Trim
113
114
115
116
Ceiling
117
118
119
120
Living Room
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Floor
121
122
123
124
Walls
125
126
127
128
Lights and Switches
129
130
131
132
Windows
133
134
135
136
Curtains
137
138
139
140
Cable Outlet
141
142
143
144
Trim
145
146
147
148
Ceiling
149
150
151
152
Bedroom
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Floor
153
154
155
156
Walls
157
158
159
160
Lights and Switches
161
162
163
164
Windows
165
166
167
168
Curtains
169
170
171
172
Doors
173
174
175
176
Trim
177
178
179
180
Ceiling
181
182
183
184
Bathroom
Rows
Missing
Repair Needed
Damaged/
Broken
Good Condition
Toilet
185
186
187
188
Walls
189
190
191
192
Lights and Switches
193
194
195
196
Bath
197
198
199
200
Curtains
201
202
203
204
Doors
205
206
207
208
Trim
209
210
211
212
Ceiling
213
214
215
216
Sink
217
218
219
220
Towel Bars
221
222
223
224
Tub or Shower
225
226
227
228
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
First Name
Last Name
Inspector Signature
Submit
Should be Empty: