EP 1110-1-31
31 Aug 01
FORM 2
BUILDING/HOUSING UNIT CONDITION
(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 point ing (if
masonry) or painting
Exterior siding has missing boards or shingles
Water stains on interior walls or ceilings
Plaster walls or ceilings deteriorated
Two or more windows or doors broken, missing, or
boarded up
Foundation has major cracks, missing material,
structure leans, or visibly unsound
Other (specify)
Other (specify)
*Total Number
*If the "Yes" column has two or more checks, the dwelling is usually considered to be in poor condition for the purposes of a lead-
hazard risk assessment. (Source: HUD Guidelines, Form 5.1)
Additional Comments:
Risk Assessor Signature and Certification Number
Date
Figure B-3: Building/Housing Unit Condition Form
B-9
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