EP 1110-1-28
31 Aug 01
FORM 1
EP 1110-1-28
BUILDING/HOUSING UNIT CONDITION
31 AUG 01
(In multi-family housing, use a separate form for each unit.)
Installation
POC
Housing Group
Street Address
Unit No.
City
State
Name of risk assessor
Condition
Yes
No
Comments
Roof missing parts of surfaces (tiles, boards,
shakes, etc.)
Roof has holes or large cracks
Gutters or downspouts broken
Chimney masonry cracked, bricks loose or
missing, obviously out of plumb
Exterior or interior walls have obvious large
cracks or holes, requiring more than routine
pointing (if masonry) or painting
Exterior siding has missing boards or shingles
Water stains on interior walls or ceilings
B-9
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