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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 D <br /> <br />righUleftlcenter: the room is situated to the right, left, 1 = Bedroom or Any Other Room Used for Sleeping (regardless of <br />or center of the unit. type of room) <br />fronUrear/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 ~ I(Failor <br />'" '~ <br />No, '" ~ If ~ail, what repairs are necessary? Inconclusive, <br /> ., <br /> a. '<ij '0 If Inconclusive, give details. date (mm/ddlyyyy) <br /> LL c <br /> ~ 6 0 If Pass with comments, give details. of final approval <br /> u <br /> z c <br />4.2 Electricity/lllumi nation <br />If Room Code is a 1, are there at least two working <br />outlets or one working outlet and one working, perma. ODD <br />nently installed light fixture? <br />If Room Code is nota 1, is there a means of illumination? ODD <br />4.3 Electrical Hazards <br />Is fhe room free from electrical hazards? ODD <br />4.4 Security <br />Are all windows and doors that are accessible from <br />the outside lockable? DO <br />4.5 Window Condition <br />If Room Code is a 1. is there at least one window? 00 <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 <br />Is the ceiling sound and tree from hazardous defects? 00 <br />4.7 Wall Condition <br />Are the walls sound and free from hazardous defects? 00 <br />4.8 Floor Condition 00 <br />Is the floor sound and free from hazardous defects? <br />4.9 Lead-Based Paint 00 <br />Are all painted surfaces free of deteriorated paint? <br />If no, does deteriorated surfaces exceed two square 00 o Not Applicable <br />feet and/or more than 10% of a component? <br />4.10 Smoke Detectors <br />Is there a working smoke detector on each level? DO <br />Do the smoke detectors meet the requirements of DO <br />NFPA 747 <br />In units occupied by the hearing impaired, is there an DO <br />alarm system connected to the smoke detector? <br /> <br />Additional Comments: (Give lIem 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 11 of20 <br /> <br />form HUD-52580-A (9//2000) <br />ref Handbook 7420.8 <br />