Health and Safety Inspection Form This form is used by program staff to record the outcomes of health and safety checks conducted in the intern housing in Washington, D.C. Date Date Format: MM slash DD slash YYYY Buchanan Apartment Number*334417434101912341432Program Staff Member*CleanlinessRoom/apartment floors are reasonably clean and free of clutter.YesNoAll appropriate University furniture is in its place.YesNoThere is no excess garbage/recycling in the apartment.YesNoWalls and windows are clean and in good repair.YesNoNo unapproved pet(s) in the apartment.YesNoNo excess dirty dishes or utensils in the kitchen.YesNoNo evidence of spoiling food/debris.YesNoBathroom toilet, sink, and shower are reasonably clean.YesNoBathroom walls and floor are reasonably clean.YesNoCleanliness CommentsSafetyWindows and doors secure properly.YesNoSafety equipment (smoke detector, flashlights, weather radio, and CO2) present and functioning correctly.YesNoThere are no hazardous extension cords.YesNoThere are no items/furniture blocking exit paths or doorways.YesNoElectrical outlets are not overloaded.YesNoNo flammable or hazardous materials present in apartment.YesNoSafety CommentsPolicyThere are observable policy violations.YesNoPolicy CommentsOverall Health and Safety CheckAs a result of the inspection, this apartment:*PassedPassed (confiscated item)Failed - Follow Up RequiredFailed - No Follow Up Required