COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAN J O A Q U I N Environmental Health Department COUNTY DAIRY FARM EMPLOYEE HOUSING ANNUAL PERMIT EXEMPTION SELF-AUDIT HOUSING INSPECTION CHECKLIST COMPLETE ONE CHECKLIST FOR EACH HOUSING UNIT FACILITYNAME: G`iS �e<<�� 76�,'> PR#: LOCATION: MAP DESIGNATION: HOUSING UNIT INFORMATION Address or identification number of unit: l Date of Inspection: Type of Housing Unit: ❑ Single Family Dwelling ['Mobile Home ❑Other: #Employees in Unit: G' Date Unit First Built or Installed: Electrical Power Provided By: Gas Provided by: HOUSING UNIT INSPECTION Interior Checklist Comments Unit has hot and cold mmning water. ❑Okay ❑Needs Re air' Approved electrical power and gas fuel being supplied to Unit. 00kay ❑Needs Repair* Heater maintained in functioning and safe manner(No spacelportable heaters). BOkay ❑Needs Repair* Doors and windows are accessible/operable to allow for safe exiting. ®Okay ❑Needs Repair* All rooms are clean and sanitary.No insecUrodent infestations present. V10kay ❑Needs Repair* All appliances(stove,water heaters,air conditioning units,heaters)are 00kay properly vented,strapped and are maintained in a safe,working order. ❑Needs Repair' All smoke and carbon monoxide detectors are present and tested to be shown p0kay in working order. ❑Needs Repair' All wiring in safe,working order(no splices,exposed wires,uncovered outlets). E30kay ❑Needs Repair* All plumbing in safe,working order(no leaks,properly maintained). QOkay ❑Needs Repair All counters,sinks,toilets,tubs,showers are working and in sanitary condition. Okay ❑Needs Repair* All floors,walls,ceilings are free from holes,are not sagging or buckling,have Q Okay no water leaks and are clean and in good condition. ❑N eds Repair* Exterior Checklist Comments Roof is properly maintained with no holes,loose shingles,leaks,etc. 00kay _ _ ❑Needs Repair* Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. POkay ❑Needs Repair* Stairways are safe with no rotting,deteriorating,or loose parts, 00kay ❑Needs Repair' Propane tank has barrier protection and'No Smoking'signage. []Okay ❑Needs Repair* The trash cans are sufficient In size,have lids and are picked up weekly. ❑Okay ❑Needs Repair* The electrical panel is covered and protected from tampering. ❑Okay ❑Needs Repair* The gas fuel connection is as approved and safe. ®okay ❑Needs Repair* There are no insect or rodent infestations. [Okay ❑Needs Re air• The sewage system is functioning,with no surfacing wastewater or backup. Okay ❑Needs Repair* *Needs Repair:Pleasespecify date repairs to be completed.Any Building Permits required for repairs must be obtained and finated. I certify that I have inspected the above noted unit and that the Information provided Is true and correct to the best of my knowledge. SIGNED: 'J DATE TmF 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com