EP 1110-1-31
31 Aug 01
FORM 3
PAINT CONDITION ON SELECTED SURFACES DATA
Installation
POC
Housing Group
Street Address
Unit No.
City
State
Name of risk assessor
Location of
Paint condition;
Deterioration
Deterioration
Building
Location
painted
type* of
due to friction
due to
Component
Notes
component with
deterioration.
or impact?
moisture?
visible bite marks
Building siding
Exterior trim
Exterior windows
Exterior doors
Railings
Porch floors
Other porch
surfaces
Interior doors
Ceilings
Walls
Interior windows
Interior floors
Interior trim
Stairways
Radiator (or
radiator cover)
Kitchen cabinets
Bathroom
cabinets
Other surfaces:
Mini blinds
*Types of deterioration: surface deterioration (chalking, mildew, or friction/impact damage); bulk deterioration (checking, cracking and flaking,
and alligatoring); layered deterioration (blistering, scaling or flaking (peeling), peeling from metal, peeling from exterior wood, peeling from
plaster walls, and peeling from masonry surfaces); or a combination. Record the overall condition of a component that is similar throughout a
dwelling. Record specific locations of any component with bite marks.
(Table adapted from 1995 HUD Guidelines, Form 5.2)
Figure B-4: Paint Condition on Selected Surfaces Data Form
B-10
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