Housing Health & Safety Ratings Survey Form

Housing Health & Safety Ratings Survey Form
Property Details:
Property ID (UPRN):
Property type:
HMO:
Property age:

1950-60's1970-80's1990-2000's2010-2020'sNew build
Is there a garden:

YesNo
Number of floors:

1234
Number of bedrooms:

1234
Number of bathrooms:

1234
General state of internal decoration:

GoodTiredPoor
Building description:
Resident Details:
Number of residents living in the property:

12345Other
Survey Details:
Physiological requirements
1. Damp and mould growth - Are there signs of damp and mould in any rooms?

YesNo
Survey Details:

Physiological requirements
1. Damp and mould growth - Are there signs of damp and mould in any rooms?

YesNo
Vulnerable age group being considered:

Under 14Over 65N/A
Area 1

If there is a Vericon sensor in the room please scan the QR Code.
Roomtype:
Room name:
Floor:
Decription:
Take Photo
Is there an extraction fan?

YesNo
Does the fan operate when the light comes on?

YesNo
Does the fan hold a piece of toilet paper when held across the face?

YesNo
Is there evidence of a dehumidifier?

YesNo
Is there a second area?

YesNo
Area 2

If there is a Vericon sensor in the room please scan the QR Code.
Roomtype:
Room name:
Floor:
Decription:
Take Photo
Is there an extraction fan?

YesNo
Does the fan operate when the light comes on?

YesNo
Does the fan hold a piece of toilet paper when held across the face?

YesNo
Is there evidence of a dehumidifier?

YesNo
Risk Rating

Explanation

Class of Harm –relates to the seriousness of the harm

Class I (Extreme Harm): This includes severehealth outcomes such as death, permanent paralysis, or other life-threateningconditions.

Class II (Severe Harm): This covers serious healthissues like respiratory diseases, significant fractures, or other conditionsrequiring prolonged medical treatment.

Class III (Serious Harm): This involves moderatehealth problems such as asthma, minor fractures, or other conditions that mayrequire medical attention but are not life-threatening.

Class IV (Moderate Harm): This includes minor healthissues like bruises, minor cuts, or other conditions that are typicallyself-treatable and do not require professional

Likelihood - relates to a 1 in X chance of an accidenthappening

Spread of Harm – is the % chance of each class ofharm. The total must be 100%

Class of Harm
2. Excess cold - Is the average temperature of habitable rooms below 18 ° C?

YesNo
3. Excess heat - Is the average temperature of habitable rooms above 23 ° C?

YesNo
4. Asbestos and manufactured mineral fibre - Are there visible signs of asbestos and manufactured mineral fibres?

YesNo
5. Biocides - Is there evidence of chemicals being used to treat timber or mould in the property?

YesNo
6. Carbon monoxide and fuel combustion products - Have Carbon monoxide sensors been installed?

YesNo
7. Lead - Threats from Lead includes vehicle exhaust fumes. Is there evidence of windows open adjacent to parked cars?

YesNo
8. Radiation - Has Radon been detected in this property or other properties locally?

YesNo
9. Uncombusted fuel gas - Is there evidence of a gas leak from any appliance within the property?

YesNo
10. Volatile organic compounds - Is there a VOC sensor within the property or any evidence gaseous organic compounds?

YesNo
11. Crowding and Space - Is there evidence of overcrowding and sufficient beds for the people living in the property?

YesNo
12. Entry by intruders - Can the doors and windows be securely closed and locked?

YesNo
13. Lighting - Is there sufficient natural or artificial lighting within the property?

YesNo
14. Noise - Is there excessive noise inside the property or within the curtilage including noise from traffic?

YesNo
PROTECTION AGAINST INFECTIONS
15. Domestic hygiene, pests and refuse
Is there adequate and hygienic means of storing and disposing of household waste.

YesNo
Is there any evidence of pestswithin the property?

YesNo
Does the design of the property facilitate the ability to keep the property clean and hygienic?

YesNo
16. Food Safety
Are food preparation areas free from cracks and damage, sink clean and in good working order including hot water, Utensils and cutlery clean, Refrigeration clean and in working order and food storage areas clean?

YesNo
17. Personal Hygiene, sanitation and drainage
Is sanitation and drainage working properly?

YesNo
Does a good standard of personal hygiene seem to be met, including personal washing and clothes washing.

YesNo
18. Water supply - Is the water supply directly from the mains water?

YesNo
PROTECTION AGAINST ACCIDENTS
19. Falls associated with baths etc - Have supports been fitted around the bath and shower?

YesNo
20. Falls on level surfaces - Are there slip trip hazards on level or slight inclined floors inside the property and within the curtilage ,including uneven surfaces or smooth surfaces that can become dangerous when wet or icy?

YesNo
21. Falls on stairs or steps
Have any surfaces around stairs, steps or ramps been identified as being a risk to falling either inside the property or within the curtilage?

YesNo
Are there sufficient handrails and balustrading to prevent falls?

YesNo
22. Falls between levels - Have any hazards beenidentified where a person could fall between levels such as out of windows, unprotectedwells or over retaining walls?

YesNo
23. Electrical hazards Is there any evidence of damaged electrical cables, appliances or electrical faceplates?

YesNo
24. Fire - Are there any uncontrolled fires in the property or within the curtilage (fires that cannot be turned off)?

YesNo
25. Hot surfaces - Is the temperature of running hot water at 60 °CIs there any evidence of unprotected heaters and water heating devices?

YesNo
26. Collision and entrapment - Can you Identify hazards that allow limbs to become trapped such as door jambs and windows Identify risk of collisions such as low ceilings or architectural glazing?

YesNo
27. Explosions
Does the gas boiler have a current LGSR test?

YesNo
Have non vented cylinders been regularly tested?

YesNo
Has any LPG appliance been tested?

YesNo
28. Ergonomics | position and use of amenities - Can you Identify any amenities that are difficult to access such as poorly positioned window locks?

YesNo
29. Structural collapse and falling elements - Can you Identify any areas of the property where disrepair is evident?

YesNo
Should be Empty:

Housing Health & Safety Ratings Survey Form

Property Details:

Resident Details:

Survey Details:

Physiological requirements

Survey Details:

Area 1

Area 2

PROTECTION AGAINST INFECTIONS

15. Domestic hygiene, pests and refuse

16. Food Safety

17. Personal Hygiene, sanitation and drainage

PROTECTION AGAINST ACCIDENTS

21. Falls on stairs or steps

27. Explosions