• Housing Health & Safety Ratings Survey Form

  • Property Details:

  • Property age:
  • Is there a garden:
  • Number of floors:
  • Number of bedrooms:
  • Number of bathrooms:
  • General state of internal decoration:

  • Resident Details:

  • Number of residents living in the property:

  • Survey Details:

  • Physiological requirements

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

  • Survey Details:

    Physiological requirements
  • 1. Damp and mould growth - Are there signs of damp and mould in any rooms?
  • Vulnerable age group being considered:

  • Area 1

    If there is a Vericon sensor in the room please scan the QR Code.
  • Is there an extraction fan?
  • Does the fan operate when the light comes on?
  • Does the fan hold a piece of toilet paper when held across the face?
  • Is there evidence of a dehumidifier?
  • Is there a second area?

  • Area 2

    If there is a Vericon sensor in the room please scan the QR Code.
  • Is there an extraction fan?
  • Does the fan operate when the light comes on?
  • Does the fan hold a piece of toilet paper when held across the face?
  • Is there evidence of a dehumidifier?

  • 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%

  • Rows
  • 2. Excess cold - Is the average temperature of habitable rooms below 18 ° C?
  • 3. Excess heat - Is the average temperature of habitable rooms above 23 ° C?
  • 4. Asbestos and manufactured mineral fibre - Are there visible signs of asbestos and manufactured mineral fibres?
  • 5. Biocides - Is there evidence of chemicals being used to treat timber or mould in the property?
  • 6. Carbon monoxide and fuel combustion products - Have Carbon monoxide sensors been installed?
  • 7. Lead - Threats from Lead includes vehicle exhaust fumes. Is there evidence of windows open adjacent to parked cars?
  • 8. Radiation - Has Radon been detected in this property or other properties locally?
  • 9. Uncombusted fuel gas - Is there evidence of a gas leak from any appliance within the property?
  • 10. Volatile organic compounds - Is there a VOC sensor within the property or any evidence gaseous organic compounds?
  • 11. Crowding and Space - Is there evidence of overcrowding and sufficient beds for the people living in the property?
  • 12. Entry by intruders - Can the doors and windows be securely closed and locked?
  • 13. Lighting - Is there sufficient natural or artificial lighting within the property?
  • 14. Noise - Is there excessive noise inside the property or within the curtilage including noise from traffic?

  • PROTECTION AGAINST INFECTIONS

  • 15. Domestic hygiene, pests and refuse

  • Is there adequate and hygienic means of storing and disposing of household waste.
  • Is there any evidence of pestswithin the property?
  • Does the design of the property facilitate the ability to keep the property clean and hygienic?

  • 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?

  • 17. Personal Hygiene, sanitation and drainage

  • Is sanitation and drainage working properly?
  • Does a good standard of personal hygiene seem to be met, including personal washing and clothes washing.
  • 18. Water supply - Is the water supply directly from the mains water?

  • PROTECTION AGAINST ACCIDENTS

  • 19. Falls associated with baths etc - Have supports been fitted around the bath and shower?
  • 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?

  • 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?
  • Are there sufficient handrails and balustrading to prevent falls?
  • 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?
  • 23. Electrical hazards Is there any evidence of damaged electrical cables, appliances or electrical faceplates?
  • 24.  Fire - Are there any uncontrolled fires in the property or within the curtilage (fires that cannot be turned off)?
  • 25. Hot surfaces - Is the temperature of running hot water at 60 °CIs there any evidence of unprotected heaters and water heating devices?
  • 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?

  • 27. Explosions

  • Does the gas boiler have a current LGSR test?
  • Have non vented cylinders been regularly tested?
  • Has any LPG appliance been tested?
  • 28. Ergonomics | position and use of amenities - Can you Identify any amenities that are difficult to access such as poorly positioned window locks?
  • 29. Structural collapse and falling elements - Can you Identify any areas of the property where disrepair is evident?
  • Should be Empty: