DSS-10a (E) Rev. 03/12/2019 (page 1 of 12)
Prior Version 10/26/2018
APARTMENT REVIEW CHECKLIST
(to be completed by City or Provider staff)
Client Name: _____________________________________________
Are there children in the Household?
Yes No
If Yes, indicate the ages of all children:
________________________________________
Shelter/Provider Name: _____________________________________
Date of apartment viewing: _______________________
Apartment Information
Address:
Year of Construction (From DHS Clearance results
document - DOB/Certificate of Occupancy section):
Apartment Number:
Floor:
Borough:
Zip Code:
Total #
rooms:
Total #
bedrooms:
Total #
baths:
Total #
of units:
Number of people who
will live in the apartment:
USE THIS FORM FOR: APARTMENT WALKTHROUGHS.
DO NOT USE THIS FORM FOR: ROOM, COMMERCIAL SRO, OR NYCHA WALKTHROUGHS.
UTILITIES (GAS, ELECTRICITY, AND WATER) MUST BE CONNECTED BY THE LANDLORD PRIOR
TO THE APARTMENT REVIEW.
1. Interior of Building
YES
NO
N/A
Information
a)
Are the interior stairs & halls free of hazards? (e.g. damaged surfaces;
peeling, cracked, & loose paint; and loose or missing handrails)
Yes = Pass
No = Fail
b)
Is there excess garbage in the hallways/interior of the building that may
cause a health and safety condition?
Yes = Fail
No = Pass
See Guidance
c)
Do halls and stairwells have a clear path to egress?
Yes = Pass
No = Fail
See Guidance
d)
Do halls and stairwells have sufficient lighting?
Yes = Pass
No = Fail
See Guidance
(Turn page)
DSS-10a (E) 03/12/2019 (page 2 of 12) Department of Social Services
Prior Version 10/26/2018
1. Interior of Building
YES
NO
N/A
Information
e)
Is there a working mailbox or mail slot for the tenant?
The mail box/slot must be unique to this unit and not shared with others.
CONFIDENTIALITY NOTICE:
If you have received this electronic transmission in error, delete it without copying or
forwarding it and notify the sender of the error.
mu
Yes = Pass
No = Fail
f)
Is this unit in a building/house with 3 or more units?
Not Pass/Fail
g)
If 1f is YES – is there at least one unlocked Fire Exit from the building?
Per NYC fire code, a fire exit is a stairway separated from other interior
spaces of a building by fire-resistant construction so that it provides a
protected path of egress out of a building.
Yes = Pass
No = Fail
h)
If 1g is YES - are any of the Fire Exits blocked?
Yes = Fail
No = Pass
i)
If 1f is YES - is there a self-closing mechanism on the apartment entrance
door, the building entrance door, and the Fire Exit doors?
Yes = Pass
No = Fail
See Guidance
j)
If 1f is YES - is there a working bell/buzzer for the apartment?
The bell or buzzer must ring inside the apartment.
Yes = Pass
No = Fail
2. Hallway and Apartment or House
YES
NO
N/A
Information
a)
Is this unit in a building/house with 3 or more units, AND are there children
10 and under in this household?
Not Pass/Fail
b)
If 2a is YES - are window guards in place in the hallways and installed with
the correct (one way) screws and L brackets to prevent the window from
opening more than 4 inches; or if there is a casement window hinged at the
side or top, is there a chain to prevent the window from opening more than
4 inches?
If the gap from the top bar of the window guard to the top of the window is
less than 4 inches, an L bracket is not required.
Note that window guards should not be installed in fire escape windows.
Yes = Pass
No = Fail
See Guidance
(Turn page)
DSS-10a (E) 03/12/2019 (page 3 of 12) Department of Social Services
Prior Version 10/26/2018
2. Hallway and Apartment or House
YES
NO
N/A
Information
c)
If 2a is YES - are window guards in place in the unit and installed with the
correct (one way) screws and L brackets; or if there is a casement window
hinged at the side or top, is there a chain to prevent the window from
opening more than 4 inches?
If the gap from the top bar of the window guard to the top of the window is
less than 4 inches, an L bracket is not required.
Note that window guards should not be installed in fire escape windows.
Yes = Pass
No = Fail
See Guidance
3. Overall Apartment/House
YES
NO
N/A
Information
a)
Is the apartment being repaired or under renovation or construction?
If the unit is being repaired or is under construction, it is not suitable for a
client.
Yes = Fail
No = Pass
b)
Is there a fire escape?
Not Pass/Fail
c)
If 3b is YES - are there window gates on the window leading to the fire
escape?
Not Pass/Fail
d)
If 3c is YES - can the window gates be opened from the inside?
For example, the gates must not have padlocks.
Yes = Pass
No = Fail
See Guidance
e)
If 3b is YES – are the window gates on the fire escape window stamped
with an FDNY approval number and can they be opened without the use
of a key?
Yes = Pass
No = Fail
See Guidance
f)
If 3b is YES - are there locks on the interior doors of the apartment that
have access to that fire escape window?
Yes = Fail
No = Pass
g)
Do the windows open, close, and lock freely?
You can ask the landlord/landlord representative to do this.
Yes = Pass
No = Fail
h)
Is there a window leading to the outside (basement, first floor, fire escape,
porch, or other outside place that can be reached from the ground)?
Not Pass/Fail
i)
If 3h is YES – is it lockable from the inside (to protect individuals from
invasion)?
Yes = Pass
No = Fail
See Guidance
j)
Are all interior surfaces free of cracked, peeling & loose paint?
Yes = Pass
No = Fail
See Guidance
(Turn page)
DSS-10a (E) 03/12/2019 (page 4 of 12) Department of Social Services
Prior Version 10/26/2018
3. Overall Apartment/House (continued)
YES
NO
N/A
Information
k)
If 3j is NO - is the date of construction 1978 or earlier?
The date of construction can be found on the Certificate of Occupancy.
This date is provided in the Department of Buildings section of the DHS
Clearance document.
Not Pass/Fail
See Box 9 on
page 10
l)
Is the unit free of evidence of rats, mice, roaches, or other vermin?
Yes = Pass
No = Fail
See Guidance
m)
Is the unit free of any evidence of leaks?
Yes = Pass
No = Fail
See Guidance
n)
Are the floors free of hazards?
For example, no gaps, tripping hazards, or protruding nails.
Yes = Pass
No = Fail
See Guidance
o)
Are there any holes in the walls, floors, or ceilings?
Yes = Fail
No = Pass
See Guidance
p)
Is each room that is used for sleeping at least 80 sq. ft., and does each
room include a window or skylight?
A room of under 80 square feet without a window can be used for another
purpose, but not for sleeping. A room used for sleeping must be both 80
square feet and have a window.
Yes = Pass
Fail = No
See Guidance
q)
Is there a lock on the inside of the apartment entrance door requiring a
key to exit the apartment?
No double cylinder locks are permitted.
Yes = Fail
No = Pass
See Guidance
r)
Is there a smoke detector located within 15 feet of the entrance to each
room that is used for sleeping?
Yes = Pass
No = Fail
See Guidance
s)
If 3r is YES - are all of the smoke detectors working?
Yes = Pass
No = Fail
See Guidance
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DSS-10a (E) 03/12/2019 (page 5 of 12) Department of Social Services
Prior Version 10/26/2018
3. Overall Apartment/House (continued)
YES
NO
N/A
Information
t)
Is there a carbon monoxide detector located within 15 feet of the
entrance to each room that is used for sleeping?
Yes = Pass
No = Fail
See Guidance
u)
If 3t is YES - are all of the carbon monoxide detectors working?
Yes = Pass
No = Fail
See Guidance
v)
Is there a heat source in every room of this unit?
Portable heating units are not permissible.
Yes = Pass
No = Fail
w)
Is the heat source a radiator?
Not Pass/Fail
x)
If 3w is YES – is there steam coming from the radiator or from the
pressure valve, or is there moisture around the pressure valve?
Yes = Fail
No = Pass
See Guidance
See Box 10 on
page 10
y)
If 3w is YES – is there evidence of leaking on, under, or around the
radiator?
Yes = Fail
No = Pass
See Guidance
See Box 10 on
page 10
z)
If 3w is YES - is the radiator missing a knob or valve?
Check the N/A box if you were unable to observe the knob or valve
due to the cover
No = Pass
Yes = Fail
See Guidance
See Box 10 on
page 10
aa)
Is this apartment in the basement, cellar, or attic?
Not Pass/Fail
See Box 11 on
Page 10
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DSS-10a (E) 03/12/2019 (page 6 of 12) Department of Social Services
Prior Version 10/26/2018
3. Overall Apartment/House (continued)
YES
NO
N/A
Information
ab)
Can the unit be accessed without having to go through another unit?
Yes = Pass
No = Fail
ac)
Does the unit have a porch or balcony?
Not Pass/Fail
ad)
If 3ac is YES – is it 30 inches or more above the ground?
Not Pass/Fail
ae)
If 3ad is YES, is a railing present and secure?
Yes = Pass
No = Fail
af)
Is there a drop ceiling (a secondary ceiling hung beneath the main
ceiling)?
Not Pass/Fail
See Guidance
See Box 12 on
Page 10
ag)
Do you have reason to think that this apartment was illegally subdivided?
Not Pass/Fail
See Guidance
See Box 13 on
Page 11
ah)
If the inspection occurs between 10/1 and 5/31 it is required for the heat to
be working.
Take the temperature in at least one room (not the bathroom or kitchen).
During the day (6 AM – 10 PM), if the outside temperature falls below 55
degrees Fahrenheit, the inside temperature must be at least 68 degrees
Fahrenheit. If the outside temperature is above 55 degrees Fahrenheit,
there is no minimum indoor temperature.
At night (between 10 PM – 6 AM), the inside temperature must be at least
62 degrees Fahrenheit at all times.
Inside Temperature:
______________
(Fahrenheit)
Outside Temperature:
______________
(Fahrenheit)
Time of day of
walk-through:
_____________
Pass = meets
specified
requirements
Fail = does not
meet specified
requirements
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DSS-10a (E) 03/12/2019 (page 7 of 12) Department of Social Services
Prior Version 10/26/2018
4. Bathroom
YES
NO
N/A
Information
a)
Do the sink, tub/standing shower, and showerhead have hot and cold
running water?
Yes = Pass
No = Fail
See Guidance
b)
Does the water in the sink, tub/standing shower, and showerhead flow
freely?
Yes = Pass
No = Fail
c)
Is the water in the sink, tub/standing shower, and showerhead clean after
flushing the pipes for at least 60 seconds (i.e. no rust)?
Yes = Pass
No = Fail
d)
Is the toilet in proper working order?
Yes = Pass
No = Fail
e)
Is there a vent or an operable window in the bathroom?
You should check for presence of vent airflow/draw.
Yes = Pass
No = Fail
f)
Is the bathroom free of plumbing leaks (including steam leaks)?
Yes = Pass
No = Fail
See Guidance
5. Kitchen
YES
NO
N/A
Information
a)
Does the kitchen sink have hot and cold running water?
Yes = Pass
No = Fail
See Guidance
b)
Is the water in the sink clean after flushing the pipe for at least 60 seconds
(i.e. no rust)?
Yes = Pass
No = Fail
c)
Is there a working oven?
Yes = Pass
No = Fail
d)
Is there a working stove?
All burners on the stove must be working.
Yes = Pass
No = Fail
e)
Is there a working refrigerator with rails and shelves adequate to the
household’s needs?
Yes = Pass
No = Fail
See Guidance
f)
Is the refrigerator cold?
Yes = Pass
No = Fail
See Guidance
(Turn page)
DSS-10a (E) 03/12/2019 (page 8 of 12) Department of Social Services
Prior Version 10/26/2018
5. Kitchen
YES
NO
N/A
Information
g)
Is there a working freezer?
Yes = Pass
No = Fail
h)
Does the kitchen have cabinets, shelves, or a space to store food?
Yes = Pass
No = Fail
See Guidance
i)
Does the kitchen have a meal preparation area (e.g., counter space)?
Yes = Pass
No = Fail
See Guidance
j)
Is the kitchen free of plumbing leaks (including steam leaks)?
Yes = Pass
No = Fail
See Guidance
k)
Is the stove or oven free of grease build-up?
Yes = Pass
No = Fail
See Guidance
l)
Is there a working vent over the stove or a window in the kitchen?
Yes = Pass
No = Fail
6. Electrical
YES
NO
N/A
Information
a)
Does each room that will be used for sleeping have either two electrical
outlets or one outlet and one permanent light fixture?
Yes = Pass
No = Fail
See Guidance
b)
Do all of the outlets in the kitchen and bathroom have a reset button
(GFCI Outlet)?
Yes = Pass
No = Fail
See Guidance
c)
Are fixtures and electrical devices secure, with no exposed wires, and do
they have plate covers?
Yes = Pass
No = Fail
See Guidance
d)
Is the apartment free of exposed wires?
Wires that connect to a cable box are not considered exposed wires.
Yes = Pass
No = Fail
See Guidance
(Turn page)
DSS-10a (E) 03/12/2019 (page 9 of 12) Department of Social Services
Prior Version 10/26/2018
6. Electrical
YES
NO
N/A
Information
e)
Are there any wires located in or located near standing water?
Yes = Fail
No = Pass
7. Accessibility – Information Gathering Only
YES
NO
N/A
Information
a)
Are there any stairs (or steps) between the public sidewalk and the door to
the unit?
Not Pass/Fail
b)
If 7a is YES - is it possible to avoid all of the stairs (or steps) between the
public sidewalk and the door to the unit by, for example, using an alternate
tenant-entrance to the building, or by using an elevator (or lift), and/or
ramp?
Not Pass/Fail
c)
Does the building have an elevator?
Not Pass/Fail
d)
If 7c is YES - is at least one in working order?
Not Pass/Fail
e)
What are the widths of the following:
Not Pass/Fail
Front entrance of the building: _______________________
Elevator door: _______________________
Entrance to the apartment: _______________________
Bathroom doors (if more than one bathroom, it is only necessary to
measure one): _______________________
To comply with the Americans with Disabilities Act, elevator doors must be
36 inches wide and doorways must be 32 inches wide.
8. Approval
YES
NO
Information
a)
Are there any other issues that would make the apartment unsuitable to rent?
If so, what are they?
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Yes = Fail
No = Pass
b)
Based on the answers you have provided above, do you approve of this
apartment for rent by this client?
Yes = Pass
No = Fail
(Turn page)
DSS-10a (E) 03/12/2019 (page 10 of 12) Department of Social Services
Prior Version 10/26/2018
9. Peeling Paint Escalation
If the answer to question 3k is YES, please email the landlord a copy of this
Apartment Review Checklist as instructed in the bottom of the last page of
this document. Please also send a completed copy of this Apartment
Walkthrough Checklist to [email protected]c.gov with the subject line
“Paint Condition.” Even if the apartment failed for other reasons, you must
still send a completed copy of this form to DHS.
YES
NO
Information
•
Was the answer YES for 3k?
Notify DHS staff if
you checked YES.
10. Radiator Escalation
Please indicate if you answered YES to any of the questions listed below. If the
landlord subsequently repairs the condition, send a copy of this completed
Apartment Review Checklist to apartmentoff[email protected]v with the subject
line “Escalation” for approval.
YES
NO
Information
•
Was the answer YES for 3x?
Notify DHS staff
if you checked
YES for any of
these items.
•
Was the answer YES for 3y?
•
Was the answer YES for 3z?
11. Basement, Cellar or Attic Escalation
Please indicate if you answered YES to the question below. If you answer YES, the
unit cannot pass at this time. You must email a completed copy of the
Apartment Review Checklist to apartmentoff[email protected] with the subject
line “Escalation” for approval.
YES
NO
Information
•
Was the answer YES for 3aa?
Notify DHS staff if
you checked YES.
12. Drop Ceiling Escalation
Please indicate if you answered YES to the question below. If you answer YES, the
unit cannot pass at this time. You must email a completed copy of the
Apartment Review Checklist to apartmentoff[email protected] with the subject
line “Escalation” for approval.
YES
NO
Information
•
Was the answer YES for 3af?
Notify DHS staff if
you checked YES.
(Turn page)
DSS-10a (E) 03/12/2019 (page 11 of 12) Department of Social Services
Prior Version 10/26/2018
13. Illegal Subdivision Escalation
Please indicate if you answered YES to the question below. If you answer YES, the
unit cannot pass at this time. You must email a completed copy of the
Apartment Review Checklist to apartmentoff[email protected] with the subject
line “Escalation” for approval.
YES
NO
Information
•
Was the answer YES for 3ag?
If so, provide the reason(s)?
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Notify DHS staff if
you checked YES.
Landlord/Landlord Representative Contact Information
Name of Landlord/Landlord Representative (Print)
Name of Organization (Print)
Email
Telephone Number
Certification
I certify that I visited the property located at the address indicated above and that the information in this form has been
answered correctly to the best of my ability.
Person completing walkthrough (Print)
Person completing walkthrough (Signature)
Date
Name of your organization (Print)
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DSS-10a (E) 03/12/2019 (page 12 of 12) Department of Social Services
Prior Version 10/26/2018
❖ A copy of this form and the Website Clearance Checklist must be included in your application request
packet. The application will not pass review if the apartment needs repair or does not pass the required
clearances.
❖ For technical support during the Apartment Review, please call 212-232-0560 from 9am to 5pm Monday
through Friday.
❖ If the unit fails under any condition, a copy of the completed Apartment Review Checklist must be
provided to the landlord via email so a record can be kept.
