Health _ Safety Pre-Inspection Worksheet - Plymouth State University

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Health _ Safety Pre-Inspection Worksheet - Plymouth State University Powered By Docstoc
					                                             University Apartments
                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.)

-Other                                                                           ______________________________

-Other                                                                           ______________________________

          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.

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