Heritage Hall | Room Condition Report
This form is to be completed within 24 hours of receiving a room key and/or moving into a residence hall room. Failure to complete and submit a Room Condition Report within 24 hours will result in a fine of $25 and will require payment for any damages incurred during the duration of stay, at the discretion of Residence Life.
First Name
*
Last Name
*
Student ID#
*
Cell Phone #
*
C-N E-mail
Which floor do you live on?
*
Please Select
1st East
2nd East
3rd East
2nd North
3rd North
3rd South
4th South
1st West
2nd West
3rd West
4th West
What is your room number?
*
Number above door
Room Key Number
This may include letters and numbers
Door
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Door Lock/Knob
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Ceiling
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Walls
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Floor
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Light Switches
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Light Fixtures
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Outlets/Jacks
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Windows
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Screens
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Blinds
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Mattress
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Wardrobe/Dresser
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Desk
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Desk Chair
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Air Conditioner/Heater
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, please explain:
Smoke Detector
*
Excellent
Good
Fair
Repair
If you selected Fair or Repair, pleases explain:
Repair Comments
Be as precise and detailed as possible
This form is to ensure that each roommate takes equal responsibility in the cleaning of the common spaces regardless of who moves out first. Any damages or cleaning fees assessed will be split equally among all room occupants. BY SUBMITTING THIS FORM, I certify that I understand that I am responsible for following the rules and regulations stated in the Guide to Residence Life which is available at www.cn.edu/reslifeguide, and that I have received my room key. By signing my name, I accept the current condition of the room and the responsibility for maintaining it as described on this report. Furthermore, I attest that the items noted were in the condition(s) specified above. I understand that I will be held financially responsible for all damages done to this room that are not specified above. I understand that, just as I checked in to the residence hall, I must setup an appointment with a C-N Residence Life staff member to check-out.
Student Signature
*
Submit
Should be Empty: