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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 />righUleftJcenter: 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 />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 = Additionat Bathroom (also check presence of sink trap and <br />clogged toilet) <br />6 = Other: <br /> <br /> Decision <br />Item Description ;: If Failor <br /> ~ .~ If Fait, what repairs are necessary? Inconclusive. <br />No. ~ ~ <br /> .. <br /> "- 'OJ " If Inconclusive, give details. date (mm/dd/yyyy) <br /> u. c <br /> ,; 0 0 If Pass with comments, give details. of final approval <br /> ~ u <br /> Z c <br />4.2 Electrlcitynllumination <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 ofillumination? ODD <br />4.3 Electrical Hazards <br />Is the 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? DO <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 free from hazardous defects? DD <br />4.7 Wall Condition <br />Are the walls sound and free from hazardous defects? DO <br />4.8 Floor Condition DO <br />Is the floor sound and free from hazardous defects? <br /> -- <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 DO 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 />00 the smoke detectors meet the requirements of DO <br />NFPA 74? <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 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 12 of 20 <br /> <br />form HUD-52580-A (9//2000) <br />ref Handbook 7420.8 <br />