Form 1.
Date:
..............................
Housing Health & Safety Rating System
Address: ......................................................................................................
Landlord Name & Address: .........................................................................
Property : House/Flat
HMO/Non HMO
Age:
Weather conditions:..............................................
1 Cold
9 Uncombusted fuels 17 Personal Hygiene 25 Burns
2 Damp & Mould
10 VOCs
18 Water Supply
26 Collision and Entrapment
3 Heat
11 Crowding & Space 19 Falls from bath 27 Explosion
4 Asbestos
12 Entry by Intruders 20 Falls on level
28 Ergonomics
5 Biocides
13 Noise
21 Falls on stairs 29 Structural Collapse
6 Carbon Monoxide etc 14 Light
22 Falls from window
7 Lead
15 Domestic Hygiene 23 Electrical hazard
8 Radiation
16 Food Safety
24 Fire Hazard
External:
Hazard:
Defect & Remedy:
___________________________________________________________________________
Internal:
Kitchen
Hazard:
Defect & Remedy
:
__________________________________________________________________________________________________
Bathroom:
Hazard
Defect & Remedy:
___________________________________________________________________________
Stairs & Landings:
Hazard:
Defect & Remedy:
