Multi-Family Health & Safety Pre-Assessment

Owner/Manager Name Property Address Email Phone Number of units in the building? Year Built Occupancy Status Fully Occupied Partially Occupied Vacant What type of heating fuel is used? Natural Gas Propane Oil Electric Other What is the age of the heating system? Under 5 yrs 5–10 yrs 10–20 yrs Over 20 yrs Is the heating system maintained yearly by licensed technician? Yes No Does each or unit, or the building, have central AC? Yes No If central AC is present, what is the approximate age? Are smoke alarms installed per code? YesNo Are CO alarms installed per code? YesNo At least one fire extinguisher in each unit? YesNo Are there any known or suspected hazards in any of this building's units? Are all kitchen and bath fans vented outside of the unit? Yes, all Some None Not sure Most recently reported issues. Are handrails on stairs with 4+ risers? Yes No Not applicable Emergency lighting and exit signage present and functioning? YesNo Most recent repairs or renovations? YesNo Repair/renovation details Are there any unpermitted appliances in the units? (water heater, hvac equipment, etc) Yes No Not sure Do all of the units have consistent heat & hot water? YesNo If No, Explain Is the electrical system maintained on a regular basis? Yes No Not sure Do you have any prior air quality or radon testing documents? YesNo I your oil tank free of any leaks? Yes No Not applicable Do tenants complain about drafts in their unit? Yes No Not sure Attic/Basement doors or hatch covers present? Yes No Not sure Interested in Funding Programs for any potenntial repairs or upgrades? YesNo Submit