Health and Safety Pre-Inspection Worksheet for Residents
(see reverse for health and safety inspection checklist)
When complete, please tape this sheet to your refrigerator!
The condition of your living space is important to us as is the quality of the service you receive when routine
maintenance is required in your apartment. Your upcoming health and safety inspection will allow staff to identify any
life/safety concerns within your apartment. However, we’d like your assistance to identify any other areas needing work
that might be more difficult for us to recognize during our brief inspection. Please take a few moments to review the
items below and comment on any areas that are in question. We will take this sheet and work with Physical Plant to
address any items requiring a work request. We thank you in advance for your attention to this matter.
Area: Frequently overlooked areas of concern: Resident Comments:
-Oven/Cook top burners, oven coils not heating ______________________________
-Refrigerator ice build-up in freezer, water leaking ______________________________
onto floor, poorly sealed doors
-Sinks dripping when faucets are turned off ______________________________
slow or clogged drains, wetness or damp-
ness under sink cabinets
-Shower water leaking from shower knobs or ______________________________
from behind fixtures, tub base missing
caulking, cracks in shower floor
-Toilet toilet that runs for long periods of ______________________________
time after flushing, toilet that fills and
drains without being flushed, water leaking
from toilet base
-Sprinklers slow drips from sprinkler heads ______________________________
-Leaks ceiling areas , window sills (leaks can be ______________________________
weather or plumbing related, please report
them immediately to the Centre Lodge.)
A Health and Safety Inspection for Apartment_______
is scheduled for _______________.
Your CA and the Apartment Manager will be conducting the brief inspection and will pick up this sheet at that
time. You do not need to be present for the inspection to occur, but you are certainly welcome to join us.