healthy home checkup assessment€¦ · recommend repairs: 7006. repair roofing and flashing as...
TRANSCRIPT
Project ID #:
Contact:
Street Address:
Date of Site Visit:
Assessor Report Date
Healthy Home Checkup Assessment
089/2016-0180
Woman, Lucky
secret location
5/7/2016
Memmer, Vickie 5/7/2016
Jackson, Wyoming 83001
Page: 1 of 42Healthy Home Checkup Assessment
What is a Healthy Home?
A “healthy home” supports and protects the health and safety of its occupants, based on the Seven Principles of Healthy Homes:
· Keep It DRY · Keep It SAFE · Keep It CLEAN · Keep It CONTAMINANT-FREE· Keep It PEST-FREE · Keep It MAINTAINED· Keep It VENTILATED
Scientists now understand how our homes can harm our health. Millions of American homes pose health and safety risks, including moisture and ventilation problems; asthma triggers; toxic exposures; and fire, electrical and tripping hazards.
Sometimes poor construction is at fault. More often, inadequate maintenance leads to hazards. Also, some homes pose challenges to occupants’ mobility, safety and independence as they age.
Fortunately, these hazards can be identified, their causes can be determined, and steps can be taken to protect occupants’ health and safety.
Healthy Home Checkup
The Healthy Home Checkup is the most cost-effective way to check for critical health and safety risks that are common in American homes. The Checkup takes an integrated approach that encompasses the structure itself, all of its major systems, and its occupants.
This Report presents the results of your Healthy Home Checkup. In most cases, photographs will highlight the identified problems. The results and recommendations are ranked in five tiers:
X - Extreme Repair Items (RED): hazard/deficiency is extremely dangerous and could immediately result in loss of life. 1 - Critical Repair Items (ORANGE): hazard/deficiency poses serious threat to health and/or safety. 2 - Recommended Repair Items (YELLOW): intended to eliminate or reduce imminent or likely hazard/deficiency, which could impact health and/or safety. 3 - Additional Opportunities to Reduce Risk (BLUE): addressing hazard/deficiency can contribute to increased health and/or safety. 4 - No Visible Hazard/Deficiency Observed (GREEN): no readily observed or detected hazard/deficiency.
Disclaimer
The Healthy Home Checkup has been developed by Healthy Housing Solutions, Inc. to provide the most cost-effective way to check a home for common problems that pose health and safety risks. The Checkup does not constitute a comprehensive health, safety and/or environmental inspection or assessment of your home. The Checkup is based on conditions observed and reported on the date of the assessment and does not predict conditions that may develop in the future. The Checkup identifies deficiencies and hazards that can be observed in readily accessible areas of your home. While this Report lists deficiencies and hazards that may result in health and/or safety risks to occupants, there is no assurance, guarantee, or express or implied warranty that all potential deficiencies and hazards have and/or could have been detected and identified during the assessment. The repair recommendations to address deficiencies and hazards identified in this Report represent general guidance based on generally accepted practices and do not provide detailed work specifications.
The assessor makes no representations regarding latent or concealed defects that may exist in your home and no warranty or guarantee is expressed or implied regarding the health status of current or future occupants. Furthermore, the assessor shall not be liable for any special, direct, indirect, or consequential damages arising out of the Checkup.
Some residential health and safety hazards can be characterized more accurately through a variety of environmental sampling and testing. If the Report identifies potential hazards of concern, you may consider hiring a qualified professional and arranging for a more detailed evaluation of your home. In every case, you should ensure the person conducting that evaluation and interpreting the results is fully qualified.
Low-Cost Repair, typically less than $100
Ongoing maintenance or behavior change
Special benefits to reduce asthma and respiratory problems
A - ApplianceC - CarpentryD - Drywall/PaintingE - ElectricalF - FlooringH - Handyman
M - MasonryP - PlumbingR - Roofing/SidingS - Other SpecialistV - Ventilation/Heating/Cooling (HVAC)N/A - Not Applicable
For each hazard identified, the Report recommends one or more corrective actions. Some recommendations are one-time repairs, while others call for ongoing changes in maintenance practices or occupant behaviors. These icons will help you set priorities to make your home healthier and safer:
The report provides an associated Trade designation for some but not all Recommended Repairs. The following is a listing of the abbreviations used:
Page: 2 of 42Healthy Home Checkup Assessment
Date of Site Visit:089/2016-0180Project ID #: 5/7/2016
Site/Property and General Building Characteristics
Before 1940 1940 - 59 1960 - 77 After 1978
Unknown
Multifamily
CondoTownhomeTriplexDuplexHouse
OtherRuralSuburbanUrban
Approximate Age:
2#of Full Bathrooms:3 # of Bedrooms:
Building Type:
Building Location:
Owner-occupied
Vacant
General Description of the Building:
Occupied
Rental
Current Occupancy:
Ownership Status: Pre-purchase
Age 4 to 10Newborn to age 3
Reported Age Categories of Current Occupants:
Age 11 to 18 Age 19 to 60
Age 61 to 75 Over age 75
Asthma or asthma symptomsAllergies
Reported Health Ailments/Conditions of Current Occupants :
Frequent headaches/migraines
Suppressed immunity
Sinus problems Skin infection/rashHay fever
Other
Other respiratory problems
Outside Weather Conditions:
Description
5% Overcast
Relative Humidity
65ºF
Temperature
< 4 PIC/LResults:
Short Term TestWhat Kind:
Other Environmental Assessment
Mold or other microbial assessment
Lead risk assessment
Lead-based paint inspection
Asbestos inspection
Radon test
Energy audit
Home inspection
Assessments Completed within the Last Year:
WhereElectrical problems
WhereUnusually cold rooms/areas
WhereUnusually hot rooms/areas
WhereFire/smoke damage
WherePests (what kind)
WhereCold spots/draftiness/air leaks
WhereUnusual odors
Crawl SpaceWhereMold/Mildew
master bathroom sink, crawl spaceWhereMoisture/water leaks
Reported Problems Identified in the Home within the Last Year:
Page: 3 of 42Healthy Home Checkup Assessment
Priority X – Extreme Priority
5/7/2016Project ID #: 089/2016-0180 Date of Site Visit:
On the date of the Healthy Home Checkup, no conditions were identified that justify Extreme Repairs.
Page: 4 of 42Healthy Home Checkup Assessment
Priority 1 – Critical Repairs
5/7/2016Project ID #: 089/2016-0180 Date of Site Visit:
The following hazards/deficiencies pose serious threats to the health and/or safety of the occupants ofthis home and should be repaired or corrected as soon as possible:
Bedroom (Bedroom 3):
Comments: No Comments
Locations: No Locations
Space heater poses potential fire hazard, including lack of tip-over safety switch3760.
Deficiency / Potential Hazard
Recommend Repairs:
Correct fire safety hazard by removing unsafe space heater (N/A)3765.
Bathroom (Bathroom 1):
Comments: No Comments
Locations: No Locations
No GFCI for receptacle within 6 feet of water9110.
Deficiency / Potential Hazard
Recommend Repairs:
Have qualified electrician install GFI receptacles or GFCI circuit for all outlets within 6 feet of
water (E)9115.
Family Room:
Comments: No Comments
Locations: No Locations
Frayed electrical cord or extension cord or cabling poses tripping hazard9120.
Deficiency / Potential Hazard
Recommend Repairs:
Reroute cords or make wiring changes to correct tripping hazard (E)9126.
Comments: No Comments
Locations: No Locations
Creosote buildup (for wood fireplace, gas fireplace, wood burning stove, pellet burning stove, coal burning stove)3720.
Deficiency / Potential Hazard
Recommend Repairs:
Have a qualified technician repair or correct. (S)3727.
Page: 5 of 42Healthy Home Checkup Assessment
Locations: No Locations
Smoke detector not present on each floor (including basement) and outside each sleeping area3800.
Laundry/Utility Room:
Comments: No Comments
Locations: No Locations
Standing water or moisture around washing machine3400.
Deficiency / Potential Hazard
Recommend Repairs:
Recommend appliance repair contractor check washer and repair or replace (A)3405.
Comments: No Comments
Locations: No Locations
Dryer exhaust duct does not vent directly outside or does not flow freely3520.
Deficiency / Potential Hazard
Recommend Repairs:
Install 4-inch rigid metal duct to exhaust outside as directly as possible with cover to keep
out pests (A, C)3525.
Attic (unfinished):
Comments: No Comments
Locations: Ceiling
Active roof leak into living space or attic7000.
Deficiency / Potential Hazard
Recommend Repairs:
Repair roofing and flashing as needed (R)7006.
Garage (attached):
Comments: No Comments
Locations: No Locations
Electric garage door opener safety sensor is missing or not working9800.
Deficiency / Potential Hazard
Recommend Repairs:
Repair garage door opener or adjust sensor to engage as designed for safety (H, S)9805.
Carbon Monoxide & Smoke Detectors:
Deficiency / Potential Hazard
Page: 6 of 42Healthy Home Checkup Assessment
Comments: No Comments
Locations: No Locations
Recommend Repairs:
Install smoke detector on every floor and outside every sleeping area, to meet code
requirements, following manufacturer’s instructions with preference for hard-wired units
(N/A)
3805.
Mechanical:
Comments: No Comments
Locations: No Locations
No GFCI for receptacle within 6 feet of water9110.
Deficiency / Potential Hazard
Recommend Repairs:
Have qualified electrician install GFI receptacles or GFCI circuit for all outlets within 6 feet of
water (E)9115.
Exterior:
Comments: No Comments
Locations: No Locations
Play equipment components missing, damaged, not well secured, or pose risk of injury1850.
Deficiency / Potential Hazard
Recommend Repairs:
Repair hazardous playground equipment or remove and dispose of safely (H)1855.
Page: 7 of 42Healthy Home Checkup Assessment
Priority 2 – Recommended Repairs
5/7/2016Project ID #: 089/2016-0180 Date of Site Visit:
The following hazards/deficiencies should be repaired to avoid conditions that could affect the healthand/or safety of the occupants within this home:
Bedroom (Bedroom 3):
Comments: No Comments
Locations: No Locations
Supply vent missing, damaged, blocked, or obstructed5000.
Deficiency / Potential Hazard
Recommend Repairs:
Move furniture or belongings obstructing vent (N/A)5005.
Comments: No Comments
Locations: No Locations
Carpeting worn, musty, or damaged6080.
Deficiency / Potential Hazard
Recommend Repairs:
Remove carpeting to reduce the risk of moisture problems and pests (F)6085.
Comments: No Comments
Locations: No Locations
Musty or damp odor7100.
Deficiency / Potential Hazard
Recommend Repairs:
Identify source and correct cause of musty smell, addressing moisture problem and/or poor
air flow and circulation (S)7105.
Consider testing for the presence of mold7124.
Comments: No Comments
Locations: No Locations
Home located in EPA Zone recommended for Radon testing7190.
Deficiency / Potential Hazard
Recommend Repairs:
Consider testing for the presence and concentration of Radon.7214.
Bathroom (Bathroom 1):
Page: 8 of 42Healthy Home Checkup Assessment
Comments: No Comments
Locations: No Locations
Bathroom exhaust fan has low air flow5110.
Deficiency / Potential Hazard
Recommend Repairs:
Clean grill if dirty or dusty (N/A)5115.
Comments: No Comments
Locations: No Locations
Wall-to-wall carpeting in bathroom poses risk of moisture and allergens6060.
Deficiency / Potential Hazard
Recommend Repairs:
Remove carpeting from bathroom to reduce the risk of moisture problems and allergens (F)6065.
Comments: No Comments
Locations: No Locations
Caulking missing, damaged or has broken seal7260.
Deficiency / Potential Hazard
Recommend Repairs:
Remove damaged caulking and repair (H)7265.
Kitchen:
Comments: No Comments
Locations: No Locations
Grease build-up on range hood or on walls or cabinets5050.
Deficiency / Potential Hazard
Recommend Repairs:
Increase kitchen ventilation by having qualified contractor install vent hood and fan that
exhausts at least 100 CFM to the outside with a sone rating of 3 or less (A, C)5055.
Always use kitchen exhaust fan when cooking (N/A)5057.
Comments: No Comments
Locations: No Locations
Grout missing7250.
Deficiency / Potential Hazard
Recommend Repairs:
Remove damaged grout and repair (H, S)7255.
Deficiency / Potential Hazard
Page: 9 of 42Healthy Home Checkup Assessment
Comments: No Comments
Locations: No Locations
Yellow flame indicates improper combustion3110.
Recommend Repairs:
Recommend qualified appliance contractor repair burner or replace stove/cook top (A)3115.
Comments: No Comments
Locations: No Locations
Garbage disposal is not working or has water leak3250.
Deficiency / Potential Hazard
Recommend Repairs:
Recommend qualified appliance contractor or plumber repair or replace garbage disposal
(A, P)3255.
Family Room:
Comments: No Comments
Locations: No Locations
Excessive clutter, debris or trash6000.
Deficiency / Potential Hazard
Recommend Repairs:
Remove and properly dispose of nonessential items and organize belongings in storage
bins (N/A)6005.
Living Room:
Comments: No Comments
Locations: No Locations
Ungrounded outlet9100.
Deficiency / Potential Hazard
Recommend Repairs:
Have qualified electrician provide ground (E)9105.
Attic (unfinished):
Comments: No Comments
Locations: Ceiling
Attic insulation with vapor barrier to cold side5200.
Deficiency / Potential Hazard
Recommend Repairs:
Page: 10 of 42Healthy Home Checkup Assessment
Reinstall/replace attic insulation using insulation of R-value recommended for climate (H)5205.
Comments: No Comments
Locations: Ceiling
Suspect mold or mildew7150.
Deficiency / Potential Hazard
Recommend Repairs:
Consider testing for the presence of mold7174.
Comments: No Comments
Locations: Ceiling
Lighting is missing, damaged, or inadequate9150.
Deficiency / Potential Hazard
Recommend Repairs:
Change burned out light bulbs (N/A)9155.
Crawlspace:
Comments: No Comments
Locations: No Locations
Standing water, moisture or mold in crawlspace7030.
Deficiency / Potential Hazard
Recommend Repairs:
Have qualified crawlspace contractor evaluate and take steps as needed to correct moisture
problem (S)7035.
Comments: No Comments
Locations: No Locations
Sump pump does not activate when float is raised7300.
Deficiency / Potential Hazard
Recommend Repairs:
Recommend qualified contractor repair or replace sump pump (P)7305.
Garage (attached):
Comments: No Comments
Locations: No Locations
Gaps/cracks/holes allow air flow between attached garage and living space5400.
Deficiency / Potential Hazard
Recommend Repairs:
Page: 11 of 42Healthy Home Checkup Assessment
Seal openings to prevent airflow between garage and conditioned space (H)5405.
Comments: No Comments
Locations: No Locations
Signs of pests6300.
Deficiency / Potential Hazard
Recommend Repairs:
Seal unvented/conditioned crawlspace to keep out pests/animals (S, H)6308.
Comments: No Comments
Locations: No Locations
Open or unguarded chemical containers8020.
Deficiency / Potential Hazard
Recommend Repairs:
Remove open or unguarded chemical containers and dispose of safely (N/A)8025.
Mechanical:
Comments: No Comments
Locations: No Locations
Furnace filter is missing, improperly sized, or dirty2160.
Deficiency / Potential Hazard
Recommend Repairs:
Install properly sized filter, at least MERV 8 (N/A)2165.
Comments: No Comments
Locations: No Locations
Water temperature at tap exceeds 120°F9400.
Deficiency / Potential Hazard
Recommend Repairs:
Adjust hot water heater temperature to 110-130 F (H, P)9405.
Comments: No Comments
Locations: No Locations
Electrical panel box cover missing, openings in the box2510.
Deficiency / Potential Hazard
Recommend Repairs:
Recommend qualified electrical contractor correct hazards in electric panel (E)2515.
Deficiency / Potential Hazard
Page: 12 of 42Healthy Home Checkup Assessment
Pool chemicals are not stored or contained4810.
Comments: No Comments
Locations: No Locations
Lighting is missing, damaged, or inadequate9150.
Recommend Repairs:
Change burned out light bulbs (N/A)9155.
Exterior:
Comments: No Comments
Locations: No Locations
Top of chimney less than 3 feet above penetration through roof or less than 2 feet higher than the roof line
within 10 feet1170.
Deficiency / Potential Hazard
Recommend Repairs:
Recommend assessment by qualified contractor based on local code requirements for
chimney height (M)1175.
Comments: No Comments
Locations: No Locations
Ground slopes toward foundation1250.
Deficiency / Potential Hazard
Recommend Repairs:
Grade yard as needed to divert water away from the foundation (S)1256.
Comments: No Comments
Locations: No Locations
Exterior door has visible air leaks1520.
Deficiency / Potential Hazard
Recommend Repairs:
Install weather-stripping (H)1525.
Comments: No Comments
Locations: No Locations
Baluster damaged, missing or spacing >4 inches9040.
Deficiency / Potential Hazard
Recommend Repairs:
Repair balusters to meet applicable code requirements (C)9045.
Deficiency / Potential Hazard
Page: 13 of 42Healthy Home Checkup Assessment
Comments: No Comments
Locations: No Locations
Recommend Repairs:
Store pool chemicals in safe and secure location (N/A)4815.
Page: 14 of 42Healthy Home Checkup Assessment
Priority 3 – Opportunities for a Healthier Home
5/7/2016Project ID #: 089/2016-0180 Date of Site Visit:
The following hazard/deficiency repairs, maintenance practices, and/or "behavior changes" could bemade in order to improve the health and/safety of the occupants within this home:
Bedroom (Bedroom 3):
Comments: No Comments
Locations: No Locations
Signs of frequent use of candles or incense8001.
Deficiency / Potential Hazard
Recommend Repairs:
Avoid frequent use of candles or incense due to particulates and chemical exposure (N/A)8006.
Kitchen:
Comments: No Comments
Locations: No Locations
Icemaker has plastic supply line3310.
Deficiency / Potential Hazard
Recommend Repairs:
Replace plastic supply line for icemaker with copper or braided steel supply line to reduce
risk of plumbing leak (A, P)3315.
Attic (unfinished):
Comments: No Comments
Locations: Ceiling
Gaps/cracks/holes around hatch or stairs to attic5250.
Deficiency / Potential Hazard
Recommend Repairs:
Weather-strip or air seal to prevent airflow from conditioned space into the attic (H)5255.
Garage (attached):
Comments: No Comments
Locations: No Locations
Signs of pests6300.
Deficiency / Potential Hazard
Recommend Repairs:
Page: 15 of 42Healthy Home Checkup Assessment
For future pest control, use gels, baits, and traps, and boric acid in crevices, instead of
insecticide sprays (N/A)6307.
Mechanical:
Comments: No Comments
Locations: No Locations
Furnace filter is missing, improperly sized, or dirty2160.
Deficiency / Potential Hazard
Recommend Repairs:
If unit is more than 10 years old, consider replacing with an Energy Star-rated unit (V)2168.
Exterior:
Comments: No Comments
Locations: No Locations
Exterior doorway lacks interior doormat to reduce dust track-in1540.
Deficiency / Potential Hazard
Recommend Repairs:
Install doormat with level loop woven nylon pile with non-slip rubber backing to reduce
track-in (N/A)1545.
Page: 16 of 42Healthy Home Checkup Assessment
Date of Site Visit:089/2016-0180Project ID #: 5/7/2016
Priority 4 - N0 Visible Hazard/Deficiency Observed
Room/Area Misc CommentRoom/Area Photo
No Comments
Bedroom 1
No Comments
Bedroom 2
No Comments
Bedroom 4
No Comments
Bathroom 2
No Comments
Dining Room
No Comments
Study/Office
Page: 17 of 42Healthy Home Checkup Assessment
No Comments
Powder Room/Half Bath
No Comments
Stairs – Interior
No Comments
Hallway/Foyer
No Comments
Enclosed Porch
No Comments
Basement (unfinished)
Page: 18 of 42Healthy Home Checkup Assessment
General Recommendations for Keeping Every HomeHealthy and Safe:
1. Do not allow smoking in the home.
2. Use “green” cleaning supplies, such as distilled vinegar, baking powder, Simple Green or Murphy’s Oil Soap.
3. Avoid frequent use of candles, air fresheners, and chemical sprays.
4. Use a doormat with dense level-loop woven nylon pile with non-slip rubber backing, and vacuum/clean it monthly
to reduce tracking in dirt and dust.
5. Vacuum frequently with a HEPA vacuum to remove small dust particles.
6. Keep humidity in the desired range of 30-50%, using a dehumidifier as needed.
7. Avoid using a humidifier, except in arid climates.
8. For forced air furnace and/or air conditioning systems, change filters every 2-3 months, and use at least a MERV 8
filter.
9. When cooking, use an exhaust fan to exhaust moisture and fumes to the exterior of the home.
10. When showering, use a bath exhaust fan for 20-30 minutes to exhaust moisture to the exterior of the home.
11. Install and then check smoke detectors and carbon monoxide detectors twice a year, and change batteries as
needed.
12. Store food in closed containers to protect against pests.
13. Avoid using pesticide sprays and bombs, particularly indoors; instead, use gels, baits, and traps, and boric acid in
crevices to control and eliminate pests.
14. Do a visual check for water leaks and moisture problems twice a year, and have repairs or service performed by a
professional as needed.
15. Keep at least one 10 pound fire extinguisher handy, particularly in the kitchen, and have a family fire evacuation
plan.
16. Perform annual checkups on the furnace, water heater, and fireplace/chimney, and have repairs or service
performed by a professional as needed.
17. Clean the lint trap of your closths dryer after every use and make sure the dryer is vented to the outside with no
obstructed airflow.
Page: 19 of 42Healthy Home Checkup Assessment
Additional Recommendations if a Young Child Lives inYour Home:
nstall window guards for upper story windows.5.
Modify cords of curtains, drapes, and blinds to correct choking hazards.4.
Use child-proof locking gates at the top and bottom of stairs.3.
Install child-proof locks on cabinet doors.2.
Install plastic covers on electrical receptacles.1.
Do not use an ozone-generating unit.10.
Use a HEPA air filter unit in the bedroom.9.
Limit the amount of upholstered furniture and window coverings in the bedroom.8.
Dust frequently using wipes that pick up dust more efficiently, such as Grab-It or Swiffer.7.
Limit the number of stuffed toys in child’s bed and wash them weekly and dry in a hot dryer for at least 30
minutes to kill dust mites.6.
Wash bedclothes weekly and dry in a hot dryer for at least 30 minutes to kill dust mites.5.
Use an allergen proof mattress cover and pillow covers to reduce dust mite exposures.4.
Keep pets out of the bedroom to reduce allergens.3.
Wash pets and their bedding frequently to reduce allergens.2.
Remove carpeting from the bedroom of occupant with asthma and dust bedroom floor frequently.1.
Additional Recommendations if an Occupant of YourHome has Asthma or Allergies:
Page: 20 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
Bedroom (Bedroom 3):
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No CommentsAML2Supply vent missing, damaged,
blocked, or obstructed5000.
No Locations; No Comments4Return vent missing, damaged,
blocked, or obstructed5010.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No CommentsA2Carpeting worn, musty, or damaged6080.
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments2Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No CommentsAML3Signs of frequent use of candles or
incense8001.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Carpeting worn, musty, or damaged6080.
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Window or room fan has no safety
cover9090.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Page: 21 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Apparent structural damage or
structural problem9850.
No Locations; No Comments4No emergency egress where
required9900.
No Locations; No Comments2Home located in EPA Zone
recommended for Radon testing7190.
Locations; CommentsTagsPrioritiesSpace Heater
No Locations; No Comments4
Unvented fuel-burning space
heater poses risks of carbon
monoxide
3750.
No Locations; No CommentsL1
Space heater poses potential fire
hazard, including lack of tip-over
safety switch
3760.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
Locations; CommentsTagsPrioritiesWindow Air Conditioner
No Locations; No Comments4Signs of water leak related to
window air conditioner3600.
No Locations; No Comments4
Signs of water infiltration or visible
air leaks around window air
conditioner
3610.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Bathroom (Bathroom 1):
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Supply vent missing, damaged,
blocked, or obstructed5000.
No Locations; No Comments4Lack of exhaust fan in bathroom5100.
No Locations; No CommentsML2Bathroom exhaust fan has low air
flow5110.
No Locations; No Comments4
Bathroom exhaust fan not vented
to outside poses potential moisture
problem
5120.
Page: 22 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No CommentsA2Wall-to-wall carpeting in bathroom
poses risk of moisture and allergens6060.
No Locations; No Comments4Gaps or cracks around perimeter of
cabinets and/or countertops6100.
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
No Locations; No Comments4Toilet not firmly secured to floor or
tank not firmly secured to bowl7200.
No Locations; No Comments4Floor tile missing, loose or
damaged7220.
No Locations; No Comments4Wall tile missing, loose or damaged7230.
No Locations; No Comments4Grout missing7250.
No Locations; No Comments2Caulking missing, damaged or has
broken seal7260.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No Comments4Signs of frequent use of candles or
incense8001.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Open or unguarded chemical
containers8020.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Occupant at risk of falling4300.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments1No GFCI for receptacle within 6 feet
of water9110.
Page: 23 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Lighting is missing, damaged, or
inadequate9150.
No Locations; No Comments4Water temperature at tap exceeds
120°F9400.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Locations; CommentsTagsPrioritiesSpace Heater
No Locations; No Comments4
Unvented fuel-burning space
heater poses risks of carbon
monoxide
3750.
No Locations; No Comments4
Space heater poses potential fire
hazard, including lack of tip-over
safety switch
3760.
Kitchen:
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Supply vent missing, damaged,
blocked, or obstructed5000.
No Locations; No Comments4Return vent missing, damaged,
blocked, or obstructed5010.
No Locations; No CommentsAML2Grease build-up on range hood or
on walls or cabinets5050.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No Comments4
Wall-to-wall carpeting in kitchen
poses risk of moisture, allergens,
and pests
6050.
No Locations; No Comments4Gaps or cracks around perimeter of
cabinets and/or countertops6100.
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
Page: 24 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
No Locations; No Comments4Floor tile missing, loose or
damaged7220.
No Locations; No Comments4Wall tile missing, loose or damaged7230.
No Locations; No Comments2Grout missing7250.
No Locations; No Comments4Caulking missing, damaged or has
broken seal7260.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No Comments4Signs of frequent use of candles or
incense8001.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Open or unguarded chemical
containers8020.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
No Locations; No Comments4Any spray pesticide container
indicates risk of chemical exposure8100.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments4No GFCI for receptacle within 6 feet
of water9110.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Lighting is missing, damaged, or
inadequate9150.
No Locations; No Comments4Class ABC fire extinguisher not
present or expired9300.
No Locations; No Comments4Water temperature at tap exceeds
120°F9400.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Locations; CommentsTagsPrioritiesDishwasher/Garbage Disposal
No Locations; No Comments4Signs of dishwasher leaking3200.
No Locations; No Comments4Dishwasher lacks backflow
prevention3210.
No Locations; No Comments2Garbage disposal is not working or
has water leak3250.
Page: 25 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Exposed electric wire, wire splice, or
junction box9130.
Locations; CommentsTagsPrioritiesRefrigerator/Freezer
No Locations; No Comments4Signs of water leak/moisture
problem around refrigerator3300.
No Locations; No CommentsA3Icemaker has plastic supply line3310.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Locations; CommentsTagsPrioritiesStove/Vent Hood
No Locations; No Comments4Stove lacks anti-tipping bracket3100.
No Locations; No Comments4Burners or oven not functioning3101.
No Locations; No CommentsA2Yellow flame indicates improper
combustion3110.
No Locations; No Comments4Vent hood re-circulates air instead
of exhausting outside3120.
No Locations; No Comments4Exhaust fan fails to exhaust outside
with adequate air flow3130.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Noticeable smell of natural gas9450.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
Locations; CommentsTagsPrioritiesAlternate Heating
No Locations; No Comments4Wood Fireplace101.
No Locations; No Comments4Gas Fireplace102.
No Locations; No Comments4Wood Burning Stove102.
No Locations; No Comments4Pellet Burning Stove104.
No Locations; No Comments4Coal Burning Stove105.
No Locations; No Comments4
Fire hazard (for wood fireplace, gas
fireplace, wood burning stove,
pellet burning stove, coal burning
stove)
3700.
No Locations; No Comments4
Flue will not open or close (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3710.
Page: 26 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Creosote buildup (for wood
fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3720.
No Locations; No Comments4
Carbon monoxide detected (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3730.
No Locations; No Comments4
Too close to combustible materials
(for wood fireplace, gas fireplace,
wood burning stove, pellet burning
stove, coal burning stove)
3740.
Locations; CommentsTagsPrioritiesSpace Heater
No Locations; No Comments4
Unvented fuel-burning space
heater poses risks of carbon
monoxide
3750.
No Locations; No Comments4
Space heater poses potential fire
hazard, including lack of tip-over
safety switch
3760.
Family Room:
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Supply vent missing, damaged,
blocked, or obstructed5000.
No Locations; No Comments4Return vent missing, damaged,
blocked, or obstructed5010.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No CommentsML2Excessive clutter, debris or trash6000.
No Locations; No Comments4Carpeting worn, musty, or damaged6080.
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
Page: 27 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No Comments4Signs of frequent use of candles or
incense8001.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Carpeting worn, musty, or damaged6080.
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Window or room fan has no safety
cover9090.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No CommentsAL1
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
No Locations; No Comments4Home located in EPA Zone
recommended for Radon testing7190.
Locations; CommentsTagsPrioritiesSpace Heater
No Locations; No Comments4
Unvented fuel-burning space
heater poses risks of carbon
monoxide
3750.
No Locations; No Comments4
Space heater poses potential fire
hazard, including lack of tip-over
safety switch
3760.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
Locations; CommentsTagsPrioritiesWindow Air Conditioner
No Locations; No Comments4Signs of water leak related to
window air conditioner3600.
Page: 28 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Signs of water infiltration or visible
air leaks around window air
conditioner
3610.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Locations; CommentsTagsPrioritiesAlternate Heating
No Locations; No Comments4Wood Fireplace101.
No Locations; No Comments4Wood Burning Stove102.
No Locations; No Comments4Pellet Burning Stove104.
No Locations; No Comments4Coal Burning Stove105.
No Locations; No Comments4Gas Fireplace102.
No Locations; No Comments4
Fire hazard (for wood fireplace, gas
fireplace, wood burning stove,
pellet burning stove, coal burning
stove)
3700.
No Locations; No Comments4
Flue will not open or close (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3710.
No Locations; No Comments1
Creosote buildup (for wood
fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3720.
No Locations; No Comments4
Carbon monoxide detected (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3730.
No Locations; No Comments4
Too close to combustible materials
(for wood fireplace, gas fireplace,
wood burning stove, pellet burning
stove, coal burning stove)
3740.
Living Room:
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Supply vent missing, damaged,
blocked, or obstructed5000.
No Locations; No Comments4Return vent missing, damaged,
blocked, or obstructed5010.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No Comments4Carpeting worn, musty, or damaged6080.
Page: 29 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No Comments4Signs of frequent use of candles or
incense8001.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Carpeting worn, musty, or damaged6080.
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Window or room fan has no safety
cover9090.
No Locations; No Comments2Ungrounded outlet9100.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
No Locations; No Comments4Home located in EPA Zone
recommended for Radon testing7190.
Locations; CommentsTagsPrioritiesSpace Heater
No Locations; No Comments4
Unvented fuel-burning space
heater poses risks of carbon
monoxide
3750.
No Locations; No Comments4
Space heater poses potential fire
hazard, including lack of tip-over
safety switch
3760.
Page: 30 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
Locations; CommentsTagsPrioritiesWindow Air Conditioner
No Locations; No Comments4Signs of water leak related to
window air conditioner3600.
No Locations; No Comments4
Signs of water infiltration or visible
air leaks around window air
conditioner
3610.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Locations; CommentsTagsPrioritiesAlternate Heating
No Locations; No Comments4Wood Fireplace101.
No Locations; No Comments4Gas Fireplace102.
No Locations; No Comments4Wood Burning Stove102.
No Locations; No Comments4Pellet Burning Stove104.
No Locations; No Comments4Coal Burning Stove105.
No Locations; No Comments4
Fire hazard (for wood fireplace, gas
fireplace, wood burning stove,
pellet burning stove, coal burning
stove)
3700.
No Locations; No Comments4
Flue will not open or close (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3710.
No Locations; No Comments4
Creosote buildup (for wood
fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3720.
No Locations; No Comments4
Carbon monoxide detected (for
wood fireplace, gas fireplace, wood
burning stove, pellet burning stove,
coal burning stove)
3730.
No Locations; No Comments4
Too close to combustible materials
(for wood fireplace, gas fireplace,
wood burning stove, pellet burning
stove, coal burning stove)
3740.
Page: 31 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
Laundry/Utility Room:
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Supply vent missing, damaged,
blocked, or obstructed5000.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
Locations; CommentsTagsPrioritiesDryer
No Locations; No Comments4Lint/dust buildup around dryer3500.
No Locations; No Comments4
Dryer exhaust duct is not solid
metal, posing risk of lint blockage
and fire
3510.
No Locations; No CommentsA1
Dryer exhaust duct does not vent
directly outside or does not flow
freely
3520.
No Locations; No Comments4Dryer exhaust components are
missing, damaged, or blocked3530.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Noticeable smell of natural gas9450.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
Locations; CommentsTagsPrioritiesWashing Machine
No Locations; No CommentsA1Standing water or moisture around
washing machine3400.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
Attic (unfinished):
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4No visible attic ventilation1160.
Ceiling; No Comments2Attic insulation with vapor barrier
to cold side5200.
Ceiling; No CommentsL3Gaps/cracks/holes around hatch or
stairs to attic5250.
Page: 32 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No Comments4Signs of pests6300.
Ceiling; No Comments1Active roof leak into living space or
attic7000.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4Musty or damp odor7100.
Ceiling; No CommentsAML2Suspect mold or mildew7150.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Open or unguarded chemical
containers8020.
No Locations; No Comments4Suspect hazardous insulation
materials8040.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Step/stair risers inconsistent height
(>3/8 inch difference) or >7 inches9020.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Window or room fan has no safety
cover9090.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Exposed electric wire, wire splice, or
junction box9130.
Ceiling; No CommentsL2Lighting is missing, damaged, or
inadequate9150.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Crawlspace:
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No Comments4Vented crawlspace has vents
obstructed or not functioning5300.
Page: 33 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Unvented or conditioned
crawlspace has visible air leaks
allowing outside air to enter
crawlspace
5312.
No Locations; No Comments4
Conditioned crawlspace is missing
insulation on foundation walls or
insulation is damaged
5320.
No Locations; No Comments4
Gaps/cracks/holes allow air to flow
from crawlspace into basement or
conditioned interior space
5330.
No Locations; No Comments4
Any exhaust fan or dryer vented
into crawlspace poises moisture
problem
5340.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No Comments4Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments2Standing water, moisture or mold in
crawlspace7030.
No Locations; No Comments4
Insulation in crawlspace hanging
from floor above suggests moisture
problem
7040.
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
No Locations; No Comments2Sump pump does not activate
when float is raised7300.
No Locations; No Comments4Cardboard boxes or cloth
belongings stored on concrete floor7400.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No Comments4Open or unguarded chemical
containers8020.
Locations; CommentsTagsPrioritiesSafety and Accessibility
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Noticeable smell of natural gas9450.
Page: 34 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Garage (attached):
Locations; CommentsTagsPrioritiesAir Flow and Circulation
No Locations; No CommentsL2
Gaps/cracks/holes allow air flow
between attached garage and living
space
5400.
Locations; CommentsTagsPrioritiesAllergens and Dust
No Locations; No Comments4Excessive clutter, debris or trash6000.
No Locations; No Comments4Wall-to-wall carpeting on concrete
poses risk of moisture problems6070.
No Locations; No Comments4Gaps/cracks/holes in ceiling, floor
or walls6200.
No Locations; No CommentsAM32Signs of pests6300.
Locations; CommentsTagsPrioritiesMoisture
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments4Musty or damp odor7100.
No Locations; No Comments4Suspect mold or mildew7150.
No Locations; No Comments4Cardboard boxes or cloth
belongings stored on concrete floor7400.
Locations; CommentsTagsPrioritiesChemical Exposure
No Locations; No Comments4Tobacco smoke/odor8000.
No Locations; No Comments4Chemical odor, sewer gas, or other
strong odor8010.
No Locations; No CommentsML2Open or unguarded chemical
containers8020.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
No Locations; No Comments4Any spray pesticide container
indicates risk of chemical exposure8100.
Locations; CommentsTagsPrioritiesSafety and Accessibility
Page: 35 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Outdoor electric receptacle is not
GFCI or lacks weather-tight cover9080.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Exposed electric wire, wire splice, or
junction box9130.
No Locations; No Comments4Lighting is missing, damaged, or
inadequate9150.
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
No Locations; No Comments1Electric garage door opener safety
sensor is missing or not working9800.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Carbon Monoxide & Smoke Detectors:
Locations; CommentsTagsPrioritiesCarbon Monoxide Detector
No Locations; No Comments4
Carbon monoxide alarm not
present on each floor and near
each bedroom
3900.
No Locations; No Comments4Carbon monoxide alarm fails test
button check3910.
Locations; CommentsTagsPrioritiesSmoke Detector
No Locations; No CommentsL1
Smoke detector not present on
each floor (including basement)
and outside each sleeping area
3800.
No Locations; No Comments4Smoke detector fails to respond to
reset button3810.
Mechanical:
Locations; CommentsTagsPrioritiesHeating System
No Locations; No Comments4Suspect hazardous material on
furnace, boiler, or heating pipes2090.
No Locations; No Comments4
Furnace exhaust not properly
attached or sealed to chimney/flue
pipe
2100.
Page: 36 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Furnace is more than 20 years old
or shows signs of operating
problems
2110.
No Locations; No Comments4Accessible HVAC ducts have visible
gaps or leaks2130.
No Locations; No CommentsAML32Furnace filter is missing, improperly
sized, or dirty2160.
No Locations; No Comments4
Furnace filter location is open and
drawing air from unconditioned
space
2170.
No Locations; No Comments4Signs of fuel oil leak2180.
No Locations; No Comments4
Use of whole house humidifier or
evaporative (swamp) cooler poses
potential moisture problems
2190.
No Locations; No Comments4Noticeable smell of natural gas9450.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
Locations; CommentsTagsPrioritiesCentral Air Conditioning
No Locations; No Comments4Condensate line does not empty
into drain fixture2210.
No Locations; No Comments4Standing water or signs of moisture
around air handler2200.
No Locations; No Comments4
A/C condenser/heat pump
compressor is more than 10 years
old or shows signs of physical
damage
2220.
Locations; CommentsTagsPrioritiesWater Heater
No Locations; No Comments4Signs of fuel oil leak2180.
No Locations; No Comments4Standing water or signs of moisture
around water heater2300.
No Locations; No Comments4
Water heater Temperature and
Pressure Relief valve/down pipe
missing or damaged
2310.
No Locations; No Comments4
Water heater exhaust gas vent not
properly attached or sealed to
chimney/flue pipe
2330.
No Locations; No Comments4
Water heater is more than 10 years
old or shows signs of operating
problems
2350.
No Locations; No CommentsAL2Water temperature at tap exceeds
120°F9400.
No Locations; No Comments4Noticeable smell of natural gas9450.
No Locations; No Comments4Elevated carbon monoxide level
detected-Above 100ppm9500.
Page: 37 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Elevated carbon monoxide levels
detected9600.
Locations; CommentsTagsPrioritiesMain Plumbing, Gas and Waste Lines
No Locations; No Comments4Main water shutoff is inaccessible
or not labeled2400.
No Locations; No Comments4Gas main shutoff is inaccessible or
not labeled2410.
No Locations; No Comments4
Standing water, visible moisture,
water staining or high humidity
indoors
7010.
No Locations; No Comments4Signs of plumbing system leak7020.
No Locations; No Comments4Signs of gas line or main leak2420.
Locations; CommentsTagsPrioritiesElectrical System
No Locations; No Comments4
Electrical service drop line damaged
or meter not properly anchored to
building
2500.
No Locations; No Comments2Electrical panel box cover missing,
openings in the box2510.
No Locations; No Comments4Knob and tube wiring is covered by
insulation or other material2540.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments1No GFCI for receptacle within 6 feet
of water9110.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Exposed electric wire, wire splice, or
junction box9130.
No Locations; No CommentsL2Lighting is missing, damaged, or
inadequate9150.
Exterior:
Locations; CommentsTagsPrioritiesRoof/Chimney
No Locations; No Comments4Active roof leak into living space or
attic7000.
No Locations; No Comments4Roofing material missing or
damaged1100.
No Locations; No Comments4Drip edge missing or damaged1110.
No Locations; No Comments4Flashing missing or damaged1120.
No Locations; No Comments4Chimney damaged or chimney cap
missing or damaged1150.
No Locations; No Comments4No visible attic ventilation1160.
Page: 38 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments2
Top of chimney less than 3 feet
above penetration through roof or
less than 2 feet higher than the roof
line within 10 feet
1170.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Locations; CommentsTagsPrioritiesGutter/Downspouts
No Locations; No Comments4Gutter blocked with leaves or debris1200.
No Locations; No Comments4Gutter/downspout components are
missing, damaged, or leaking1210.
No Locations; No Comments4Downspout discharges water next
to foundation1230.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesFoundation/Grading
No Locations; No Comments4Signs of standing water or erosion
next to foundation1240.
No Locations; No Comments2Ground slopes toward foundation1250.
No Locations; No Comments4Foundation components/materials
are missing or damaged1300.
No Locations; No Comments4Gaps/cracks/holes in foundation1310.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Locations; CommentsTagsPrioritiesSiding/Trim
No Locations; No Comments4Gaps/cracks/holes in exterior
siding/trim1320.
No Locations; No Comments4Siding or trim missing or damaged1330.
No Locations; No Comments4Suspect hazardous materials in
siding or trim1340.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesDoors/Windows
No Locations; No Comments4
Exterior door does not
open/close/lock properly, or
components are missing or
damaged
1500.
No Locations; No CommentsL2Exterior door has visible air leaks1520.
No Locations; No Comments4Caulking around door frame/trim
missing or damaged1530.
Page: 39 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No CommentsAL3Exterior doorway lacks interior
doormat to reduce dust track-in1540.
No Locations; No Comments4Caulking/flashing around window
frame/trim is missing or damaged1550.
No Locations; No Comments4Broken glass or other visible
window problems1560.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
Locations; CommentsTagsPrioritiesDriveways/Steps/Decks/Porches/Patios
No Locations; No Comments4Steps/porch/deck components
missing or damaged1600.
No Locations; No Comments4Driveway/walkway/patio is
damaged1610.
No Locations; No Comments4House numbers not visible from
street1620.
No Locations; No Comments4Grilling or smoking equipment
poses potential fire hazard1800.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
No Locations; No Comments4Slip/trip/fall hazard9000.
No Locations; No Comments4Step/stair risers inconsistent height
(>3/8 inch difference) or >7 inches9020.
No Locations; No Comments2Baluster damaged, missing or
spacing >4 inches9040.
No Locations; No Comments4Flooring/subflooring is damaged9070.
No Locations; No Comments4Lighting is missing, damaged, or
inadequate9150.
No Locations; No Comments4Apparent structural damage or
structural problem9850.
Locations; CommentsTagsPrioritiesElectric/Plumbing
No Locations; No Comments4Hose bib/faucet leaking or lacks
backflow prevention1730.
No Locations; No Comments4Signs of septic system seepage to
surface1740.
No Locations; No Comments4Outdoor electric receptacle is not
GFCI or lacks weather-tight cover9080.
No Locations; No Comments4Ungrounded outlet9100.
No Locations; No Comments4No GFCI for receptacle within 6 feet
of water9110.
No Locations; No Comments4
Frayed electrical cord or extension
cord or cabling poses tripping
hazard
9120.
No Locations; No Comments4Exposed electric wire, wire splice, or
junction box9130.
Page: 40 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4
Radon mitigation system motor
and ducting not functioning
properly
2600.
Locations; CommentsTagsPrioritiesYard/Landscaping/Walkways/Driveways
/Steps/Decks.
No Locations; No Comments4Grilling or smoking equipment
poses potential fire hazard1800.
No Locations; No Comments4Materials, debris, vegetation offers
harborage to pests1810.
No Locations; No Comments4
Bushes/ivy/trees encroach on home
posing potential risk of moisture
and pests
1820.
No Locations; No Comments4
Dead or rotting tree/limb poses
potential risk of injury or damage to
home
1830.
No Locations; No Comments4Garbage/trash/recycling not stored
or contained1840.
Locations; CommentsTagsPrioritiesFence/Gate/Play Equipment
No Locations; No CommentsL1
Play equipment components
missing, damaged, not well
secured, or pose risk of injury
1850.
No Locations; No Comments4Fence components missing,
damaged, or fail to operate1880.
No Locations; No Comments4Well is uncapped or improperly
capped1890.
No Locations; No Comments4Paint is peeling, damaged, or
deteriorated8030.
No Locations; No Comments4
Gasoline or other petroleum
products not stored in secure
container
9700.
Locations; CommentsTagsPrioritiesPool/Hot Tub/Spa
No Locations; No Comments4Pool or spa pipes and fitting are
leaking4800.
No Locations; No CommentsML2Pool chemicals are not stored or
contained4810.
No Locations; No Comments4Pool not guarded by fence4820.
No Locations; No Comments4Pool gate(s) not self-closing with
self-latching childproof latch4830.
No Locations; No Comments4Pool main drain grate appears to be
missing or not secure4840.
No Locations; No Comments4Electrical wiring passes directly
overhead pool or spa4850.
No Locations; No Comments4
Pool water height is insufficient to
provide continuous overflow
through gutters and skimmer
4880.
Page: 41 of 42Healthy Home Checkup Assessment
Appendix A - Full Listing
Project ID #: Date of Site Visit:089/2016-0180 5/7/2016
No Visible Issues Observed4
Additional Opportunity to Reduce Risk3
Recommended Repair2
Priority Repair1
Extreme PriorityX
Reduced Asthma RiskA
Maintenance/Behavior ChangeM
Low Cost RepairL
No Locations; No Comments4Pool water is discolored or suspect
algae growth is present4890.
No Locations; No Comments4Hot tub/spa is uncovered when not
in use4910.
No Locations; No Comments4Electrical receptacle within 20 feet
of pool/spa is not GFCI4860.
No Locations; No Comments4Electrical receptacle (even if GFCI) is
within 10 feet of pool4870.
Page: 42 of 42Healthy Home Checkup Assessment