Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Housing Survey - Interior Conditions

  1. Was your home built before 1978?*

  2. Do you have any roof leaks at this time?*

  3. Do fuses blow or breakers trip?*

  4. Do you have enough light fixtures?*

  5. Do all of the light fixtures work?*

  6. Do all of the electrical outlets work? *

  7. Do you have enough electrical outlets? *

  8. Do any of your kitchen faucets or pipes leak?*

  9. Do any of your bathroom faucets, pipes or toilets leak? *

  10. Is the paint inside your home peeling and cracking? *

  11. Is the insulation in your home adequate?*

  12. Do any of your faucets, pipes or toilets drain slowly or back up?*

  13. Do you think the heating/cooling system in your home is adequate?*

  14. Does your home have a smoke alarm? *

  15. Does your home have a carbon monoxide (CO2) alarm? *

  16. Are any of your floors uneven or sagging?*

  17. Do you own or rent your home?*

  18. Sector Selection Map

    Use this map to answer the next question.

  19. Leave This Blank:

  20. This field is not part of the form submission.