Name, relationship and Age for each person
Installing grab bars, shower seats, wheelchair ramps,
Securing or installing stair hand rails, etc.
Describe problems with doors, floors, porches, steps, walls, ceilings, etc.
Indicate places in house needing repair
List rooms where wall outlets, switches, and light fixtures do not work.
Describe sink, tub or toilet leaks, etc.
Identify where roof leaks
List all interior rooms that require painting and any exterior painting requirements.
Identify appliances such as stove, refrigerator or hot water heater that do not work or need repair.
Describe repairs required, including locks, glass, frames, weather-stripping, etc
Indicate if there is cleaning and/or trash removal required. Identify necessary yard work
Identify other repairs requested but not listed above