Room Inspection Form
Select One *
Required
Submission Date *
MM
/
DD
/
YYYY
First Name *
Your answer
Last Name *
Your answer
House
Room Number *
Your answer
Room Furniture Guide
Good: item has only minor wear & tear
Acceptable: item functions but will need repair/replacement in 1-3 years
Poor: item needs repair/replacement in less than 1 year
*
Good
Acceptable
Poor
Missing
Bedframe
Mattress
Desk
Chair
Blinds/Curtains
Walls
Door Lock
Screen
Floor Condition
*
Carpet
Tile
Wood
Combination
Floor Type
Additional Comments
Your answer
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