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<br />4. Supplemental for Other Rooms Used for Living and Halls For each numbered item. check one box only. <br /> <br />4.1 Room Location Room Code 0 <br /> <br />right/left/center: the room is situated to the right. left, 1 : Bedroom or Any Other Room Used for Sleeping (regardless of <br />or center of the unil. type of room) <br />fronVrear/center: the room is situated to the back, front 2 = Dining Room or Dining Area <br />or center of the unit. 3: Second Living Room, Family Room, Den, Playroom. TV Room <br />floor level: the floor level on which the room is 4 = Entrance Halls. Corridors, Halls, Staircases <br />located. 5 Additional Bathroom (also check presence of sink trap and <br />clogged toilet) <br />6: Other: <br /> <br /> Decision <br />Item Description ~ If Fail, what repairs are necessary? If Failor <br /> ~ ';;; <br />No, 0 If Inconclusive, give details. Inconclusive, <br /> ~ ~ <br /> "'- ',. " If Pass with comments, give details. date of final <br /> u. c <br /> .; 0 <br /> ~ 0- 0 approval <br /> z c <br />4.2 Electricity/Illumination <br />If Room Code is a 1, are there at least two working <br />outlets or one working outlet and one working, perma- 000 <br />nently installed light fixture? <br />If Room Code is nota 1, is there a means ofilluminatiC?n? ODD <br />4.3 Electrical Hazards 000 <br />Is the room free from electrical hazards? <br />4.4 Security <br />Are all windows and doors that are accessible from DO <br />the outside lockable? <br />4.5 Window Condition 00 <br />If Room Code is a 1, is there at least one window? <br />And, regardless of Room Code, are all windows free <br />of signs of severe deterioration or missing or broken~ DO <br />out panes? <br />4.6 Ceiling Condition 00 <br />Is the ceiling sound and free from hazardous defects? <br />4.7 Wall Condition DO <br />Are the walls sound and free from hazardous defects? <br />4.8 Floor Condition DO <br />Is the floor sound and free from hazardous defects? <br />4.9 Lead-Based Paint DO <br />Are all painted surfaces free of deteriorated paint? <br />If no, does deteriorated surfaces exceed two square 00 ~ Not Applicable <br />feet and/or more than 10% of a component? <br />4.10 Smoke Detectors 00 <br />/5 there a working smoke detector on each level? <br />00 the smoke detectors meet the requirements of DO <br />NFPA 74? <br />In units occupied by the hearing impaired, is there an 0 0 <br />alarm system connected to the smoke detector? <br /> <br />Additional Comments: (Give item Number)(Use an additional page if necessary) <br /> <br />Comments continued on a separate page Yes 0 <br /> <br />No 0 <br /> <br />Previous editions are obsolete <br /> <br />Page 10 of 20 <br /> <br />form HUD.525SD-A (9//2000) <br />ref Handbook 7420.8 <br />