Worker Housing Inspection Form

Worker Housing Inspection Form
Complete this form to document the inspection of worker housing units, including condition, safety, cleanliness, and any maintenance needs.
Inspection Reference ID
Date of Inspection
MonthDayYear
Date
Inspector Name
First NameLast Name
Inspector Contact Email
example@example.com
Housing Unit Address/Location
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Occupant or Site Manager Name
First NameLast Name
Contact Phone Number (Occupant or Manager)
Please enter a valid phone number.Format: (000) 000-0000.
Room/Area Condition Checks
Rows Good Needs Attention Not Applicable
Sleeping Area
Kitchen
Bathroom
Common Areas
Exterior
Safety and Cleanliness Checks
Other (please specify)
List Any Maintenance Issues Found
Severity/Priority of Issues
Upload Photos or Documents
Cancelof
Inspector Notes or Additional Comments
Recommended Follow-up Actions
Should be Empty:

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