New HUD Form XXXX NSPIRE HCV/PBV Inspection Checklist

NSPIRE HCV/PBV INSPECTION CHECKLIST
PHA:
Family Identifier:
Any children under 6 reside or expected to reside in the unit? (Y/N):
Inspector:
Date of Inspection:
Type of Inspection:
Summary Decision on Unit (Pass/Fail):

Area

Carbon Monoxide

Ceiling

Chimney

Owner:
Owner Contact Information:
Housing Type:
Year Constructed:
Number of Bedrooms:
Health & Safety Designation

Correction Timeframe (P/F)

LT

Life-Threatening - 24 Hours (Fail)

S

Severe - 30 Days (Fail)

M

Moderate - 30 Days (Fail)

Mark all that apply:

L

Low - N/A (Pass)

Deficiency Description

Unit

A bathtub or shower is inoperable or does not drain and at least 1 bathtub or shower is present elsewhere
that is operational.
Bathtub component or shower component is damaged, inoperable, or missing such that it may limit the
Bathtub and Shower
resident's ability to maintain personal hygiene.
Bathtub component or shower component is damaged, inoperable, or missing and it does not limit the
resident's ability to maintain personal hygiene.
Bathtub or shower cannot be used in private.*

Call-For-Aid System

Address of Unit:

*Affirmative Habitability Requirement per 24 CFR 5.703(d) and NSPIRE Final Rule

Address and Signage Address, signage, or building identification codes are broken, illegible, or not visible.
Only 1 bathtub or shower is present and it is inoperable or does not drain.

Cabinet and Storage

OMB Control Number: 2577-NEW

Food storage space is not present.*

Inside

M
S

L

M

L

M

L

L
*M

M

*M

Storage component is damaged, inoperable, or missing.

M

L

System is blocked, or pull cord is higher than 6 inches off the floor.

LT

LT

System does not function properly.

LT

LT

Carbon monoxide alarm is missing, not installed, or not installed in a proper location.*

LT

Carbon monoxide alarm is obstructed.

LT

LT

Carbon monoxide alarm does not produce an audio or visual alarm when tested.

LT

LT

Ceiling has an unstable surface.

M

M

Ceiling has a hole.

M

M

Ceiling component(s) is not functionally adequate.

S

S

LT

LT

A visually accessible chimney, flue, or firebox connected to a fireplace or wood-burning appliance is
incomplete or damaged such that it may not safely contain fire and convey smoke and combustion
gases to the exterior.
Chimney exhibits signs of structural failure.

Outside Inspector Comments

LT
LT

Area

Deficiency Description

LT

LT

LT

LT

Clothes Dryer Exhaust
Dryer transition duct is constructed of unsuitable material.
Ventilation
Gas dryer exhaust ventilation system has restricted airflow.

Exterior dryer vent cover, cap, or a component thereof is missing.
Cooking range, cooktop, or oven does not ignite or produce heat.
Cooking range, cooktop, or oven component is damaged or missing such that the device is unsafe for use.
Primary cooking appliance is missing.*
A microwave is the primary cooking appliance and it is damaged.
A burner does not produce heat, but at least 1 other burner is present on the cooking range or cooktop
and does produce heat.
Entry door will not open.

Door - Entry

LT

LT

LT

LT

LT

LT

S

L

M

M

M

M
M
M

Entry door self-closing mechanism is damaged, inoperable, or missing.

S

M

Hole, split, or crack that penetrates completely through entry door.

M

M

Entry door is missing.

LT

S

Entry door surface is delaminated or separated.

M

M

Entry door frame, threshold, or trim is damaged or missing.

M

M

Entry door seal, gasket, or stripping is damaged, inoperable, or missing.

M

M

L

L

S

M

S

S

S

S

S

S

S

S

S

S

S
LT
M

M
LT
M

L

L

Fire labeled door is missing.
A passage door does not open.
A passage door component is damaged, inoperable, or missing and the door is not functionally adequate.
Door - General
A door that is not intended to permit access between rooms has a damaged, inoperable, or missing
An exterior door component is damaged, inoperable, or missing.

LT

S

S

An object is present that may prevent the fire labeled door from closing and latching or self-closing and
latching.
Fire labeled door cannot be secured.

LT

*M

M

Fire labeled door does not close and latch or the self-closing hardware is damaged or missing such that the
door does not self-close and latch.
Fire labeled door assembly has a hole of any size or is damaged such that its integrity may be
compromised.
Fire labeled door seal or gasket is damaged or missing.

Outside Inspector Comments

L

Entry door will not close.

Entry door component is damaged, inoperable, or missing and it does not limit the door’s ability to
provide privacy or protection from weather or infestation.
Entry door cannot be secured.
Fire labeled door does not open.

Door - Fire

Inside

Gas dryer transition duct is detached or missing.
Electric dryer exhaust ventilation system has restricted airflow.

Cooking Appliance

Unit

Electric dryer transition duct is detached or missing.

L
M

Area

Deficiency Description
Drain
Egress

Unit

Inside

Outside Inspector Comments

Drain is fully blocked.

M

M

M

Obstructed means of egress.

LT

LT

LT

Sleeping room is located on the 3rd floor or below and has an obstructed rescue opening.

LT

Fire escape access is obstructed.

LT

Outlet or switch is damaged.

LT

LT

LT

S

S

S

Testing indicates a three-pronged outlet is not properly wired or grounded.
Electrical - Conductor,
Outlet does not have visible damage and testing indicates it is not energized.
Outlet, and Switch
Exposed electrical conductor.

S

S

S

LT

LT

LT

Water is currently in contact with an electrical conductor.

LT

LT

GFCI outlet or GFCI breaker is not visibly damaged and the test or reset button is inoperable.

S

S

S

Electrical - GFCI/AFCI AFCI outlet or AFCI breaker is not visibly damaged and the test or reset button is inoperable.

S

S

S

*S

*S

*S

An unprotected outlet is present within six feet of a water source.*
Electrical - Service
Panel

Elevator

Exit Sign
Fence and Gate
Fire Escape
Fire Extinguisher

Flammable and
Combustible Item

Floor

Food Preparation

Electrical service panel is not readily accessible.

M

M

M

The overcurrent protection device is damaged.

LT

LT

LT

The overcurrent protection device is contaminated.

S

S

S

Elevator is inoperable.

M

Elevator door does not fully open and close.

M

Elevator cab is not level with the floor.

M

Safety edge device has malfunctioned or is inoperable.

M

Exit sign is damaged, missing, obstructed, or not adequately illuminated.

LT

LT

Fence component is missing.

M

Gate does not open, close, latch, or lock.

M

Fence demonstrates signs of collapse.

M

Fire escape component is damaged or missing.

LT

Fire extinguisher pressure gauge reads over or under-charged.

LT

LT

LT

Fire extinguisher service tag is missing, illegible, or expired.

LT

LT

LT

Fire extinguisher is damaged or missing.

LT

LT

LT

Flammable or combustible item is on or within 3 feet of an appliance that provides heat for thermal
comfort or a fuel-burning water heater.
OR
Improperly stored chemicals.

LT

LT

LT

Floor substrate is exposed.

M

M

Floor component(s) is not functionally adequate.

M

M

Food preparation area is not present.*

*M

Food preparation area is damaged or is not functionally adequate.

M

M

Area

Deficiency Description

Foundation

Unit

Inside

M

M

M

Foundation has exposed rebar or foundation is spalling, flaking, or chipping.

M

M

M

Foundation is infiltrated by water.

M

M

Foundation support post, column, beam, or girder is damaged.

M

M

Foundation vent cover is missing or damaged.
Garage Door

Grab bar
Guardrail

Handrail

Garage door has a hole.

M

M

M

Garage door does not open, close, or remain open or closed.

M

M

M

Grab bar is not secure.

M

M

Guardrail is missing or not installed.*

*LT

*LT

*LT

Guardrail is not functionally adequate.

LT

LT

LT

Handrail is missing.

M

M

M

Handrail is not secure.

M

M

M

Handrail is not functionally adequate.

M

M

M

L

L

The inspection date is on or between October 1 and March 31 and the permanently installed heating
source is not working or the permanently installed heating source is working and the interior
temperature is below 64 degrees Fahrenheit.*
The inspection date is on or between October 1 and March 31 and the permanently installed heating
source is working and the interior temperature is 64 to 67.9 degrees Fahrenheit.*

*LT

*S

Air conditioning system or device is not operational.

M

L

Unvented space heater that burns gas, oil, or kerosene is present.*

*LT

*LT

Combustion chamber cover or gas shutoff valve is missing from a fuel burning heating appliance.

LT

LT

Heating system or device safety shield is damaged or missing.

S

S

*M

*M

LT

LT

The inspection date is on or between April 1 and September 30 and a permanently installed heating
source is damaged, inoperable, missing, or not installed.*
Fuel burning heating system or device exhaust vent is misaligned, blocked, disconnected, improperly
connected, damaged, or missing.
The inspection date is on or between October 1 and March 31 and the permanently installed heating
source is inoperable.
Evidence of cockroaches.
Extensive cockroach infestation.

LT

M
M
S

M
M

M

M

Extensive bedbug infestation.

S

M

Evidence of mice.

M

M

Extensive mouse infestation.

S

M

Evidence of rats.

M

M

Extensive rat infestation.

S

S

Evidence of other pests.

M

M

Evidence of bedbugs.
Infestation

M
M

Handrail is not installed where required.

HVAC

Outside Inspector Comments

Foundation is cracked.

M

Area

Deficiency Description

Leak - Gas/Oil

Leak - Sewage

Leak - Water

LT

LT

S

S

S

Leak in sewage system.

S

S

S

Cap to the cleanout or pump cover is detached or missing.

M

M

M

Cleanout cap or riser is damaged.

M

M

M

Environmental water intrusion.

M

M

Plumbing leak.

M

M

L

Fluid is leaking from the sprinkler assembly.

M

M

L

S

S

Lighting - Exterior

A permanently installed light fixture is damaged, inoperable, missing, or not secure.

Minimum Electrical
and Lighting

Mold-Like Substance

Parking Lot

M

M

A permanently installed light fixture is not secure.

M

M

At least one (1) permanently installed light fixture is not present in the kitchen and bathroom.*

*M

*M

Litter is accumulated in an undesignated area.

M

At least two (2) working outlets are not present within each habitable room. OR At least one (1) working
outlet and one (1) permanently installed light fixture is not present within each habitable room.*

*M ✔

Presence of mold-like substance at moderate levels is observed visually.

M

L

Presence of mold-like substance at high levels is observed visually.

S

M

Presence of mold-like substance at extremely high levels is observed visually.

LT

S

Elevated moisture level.

M

L

L

Parking lot has any one pothole that is 4 inches deep and 1 square foot or greater.

M

Parking lot has ponding.

M

Paint in a Unit or Inside the target property is deteriorated – above the level required for lead-safe work
Potential Lead-Based
practices by a lead-certified firm and passing clearance.
Paint Hazards - Visual
Paint
Outside on a target property is deteriorated – below the level required for lead-safe work practices
Assessment
by a lead-certified firm or for passing clearance.
Paint Outside on a target property is deteriorated – above the level required for lead-safe work practices
by a lead-certified firm and passing clearance.
Private Roads and Road or driveway access to the property is blocked or impassable for vehicles.

Refrigerator

M

A permanently installed light fixture is inoperable.

Paint in a Unit or Inside the target property is deteriorated – below the level required for lead-safe work
practices by a lead-certified firm or for passing clearance.

Driveways

Outside Inspector Comments

LT

Auxiliary lighting is damaged, missing, or fails to illuminate when tested.

Litter

Inside

Blocked sewage system.

Lighting - Auxiliary

Lighting - Interior

Unit

Natural gas, propane, or oil leak.

M

M

S

S
M
S
S

Road or driveway has any one pothole that is 4 inches deep and 1 square foot or greater.

M

Refrigerator is inoperable such that it may be unable to safely and adequately store food.

M

M

Refrigerator component is damaged such that it impacts functionality.

M

M

Refrigerator is missing.*

*M

Area

Deficiency Description

Retaining Wall

Roof Assembly

Sharp Edges

Unit

Inside

M

Retaining wall is partially or completely collapsed.

M

Restricted flow of water from a roof drain, gutter, or downspout.

M

Gutter component is damaged, missing, or unfixed.

M

Roof surface has standing water.

M

Substrate is exposed.

M

Roof assembly has a hole.

M

Roof assembly is damaged.

M

A sharp edge that can result in a cut or puncture hazard is present.

S

S

Sidewalk, Walkway, Sidewalk, walkway, or ramp is blocked or impassable.
Ramp
Sidewalk, walkway, or ramp is not functionally adequate.

Sink

Site Drainage

M

Sink or sink component is damaged or missing and the sink is not functionally adequate.

M

L

Water is directed outside of the basin.

L

L

Sink is not draining.

M

M

M

M

Sink is improperly installed, pulling away from the wall, leaning, or there are gaps between the sink and
wall.
Sink component is damaged or missing and the sink is functionally adequate.

L

L

Cannot activate or deactivate hot and cold water.*

*M

M

Sink is missing or not installed within the primary kitchen.*

*M

Water runoff is unable to flow through the site drainage system.

L

Erosion is present.

L
*LT

*LT

Smoke alarm is obstructed.

LT

LT

Smoke alarm does not produce an audio or visual alarm when tested.

LT

LT

LT

LT

LT

LT

Sprinkler assembly has evidence of corrosion.

LT

LT

LT

Sprinkler assembly has evidence of foreign material that is detrimental to performance.

LT

LT

LT

Tread is missing or damaged.

M

M

M

Stringer is damaged.

M

M

M

Sprinkler Assembly

Steps and Stairs
Structure

M

Smoke alarm is not installed where required.*

Sprinkler head assembly is encased or obstructed by an item or object that is within 18 inches of the
sprinkler head.
Sprinkler assembly component is damaged, inoperable, or missing and it is detrimental to performance.

Stairs

S
M

Grate is not secure or does not cover the site drainage system’s collection point.
Smoke Alarm

Outside Inspector Comments

Retaining wall is leaning away from the fill side.

Step or stair is not functionally adequate.
Structural system exhibits signs of serious failure.

LT

M
LT

LT

LT

Area

Deficiency Description

Toilet

Trip Hazard

Ventilation

Wall - Exterior

Wall - Interior

LT

M

M

M

Only 1 toilet was installed, and it is damaged or inoperable.

S

M

A toilet is damaged or inoperable and at least 1 toilet is installed elsewhere that is operational.

M

M

M

M

M

M

L

L

*M

M

Toilet component is damaged, inoperable, or missing such that it may limit the resident’s ability to safely
discharge human waste.
Toilet is not secured at the base.

Chute door does not open or self-close and latch.

M

Chute is clogged.

M

Trip hazard on walking surface.

M

M

Exhaust system does not respond to the control switch.

M

M

Exhaust system has restricted airflow.

M

M

Exhaust system component is damaged or missing.

M

M

Bathroom does not have proper ventilation or dehumidification.

M

M

Window

Outside Inspector Comments

M

Exterior wall covering has missing sections of at least 1 square foot per wall.

M

Exterior wall has peeling paint of 10 square feet or more.

M

Exterior wall component(s) is not functionally adequate.

M

Interior wall has a loose or detached surface covering.

M

M

Interior wall component(s) is not functionally adequate.

M

M

M

M

S

S

S

L

Interior wall has a hole that is greater than 2 inches in diameter or there is an accumulation of holes that
are cumulatively greater than 6 inches by 6 inches.
Temperature pressure relief (TPR) valve has an active leak or is obstructed or relief valve discharge piping
is damaged, capped, has an upward slope, or is constructed of unsuitable material.
No hot water.
Water Heater

Inside

A toilet is missing and at least 1 toilet is installed elsewhere that is operational.

Toilet component is damaged, inoperable, or missing and it does not limit the resident’s ability to
discharge human waste.
Toilet cannot be used in private.*
Trash Chute

Unit

Only 1 toilet was installed, and it is missing.

S

The relief valve discharge piping is missing or terminates greater than 6 inches or less than 2 inches from
waste receptor flood-level.
Chimney or flue piping is blocked, misaligned, or missing.

M

M

M

LT

LT

LT

Gas shutoff valve is damaged, missing, or not installed.

LT

LT

LT

Window will not open or stay open.

M

L

Window cannot be secured.

M

L

Window will not close.

S

M

Window component is damaged or missing and the window is not functionally adequate.

M

M

Burden Statement: The purpose of this information collection is to strengthen the U.S. Department of Housing and Urban Development (HUD)’s physical condition standards and improve HUD’s oversight of housing pursuant to the National Standards for the Physical Inspection of Real
Estate (NSPIRE) inspection regulations, requirements, and procedures. The information collected on this optional checklist form will be used by Public Housing Agencies (PHAs) to determine if a housing unit meets NSPIRE Standards for the Housing Choice Voucher (HCV) and Project
Based Voucher (PBV) programs. This is a voluntary form and not required for use. Additionally, assurances of confidentiality are not provided under this collection. The public reporting burden for this collection of information is estimated to average 1 hour per response , including
the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Office of Policy and Partnerships, Real Estate Assessment Center, Office of Public and Indian Housing, Department of Housing and
Urban Development, 550 12th Street SW, Suite 100, Washington, DC 20410‐4000. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid control number.