Name:_________________ Bathroom Intercom doesn’t work

Other:
Address:_______________ Ceiling falling
Ceiling fell Public Areas and Building
Ceiling cracked Grounds:
City, State,
Ceiling leaking Entrance door broken
ZIP:___________________ Plaster falling Entrance door lock broken
Floors broken or warped Holes in entrance door
Phone:_________________ Walls cracked or bulging No entrance door
Radiators, steam pipes leaking Bells/buzzers don’t work
Monthly Window pane cracked, broken Inadequate/no lighting
Rent:__________________ Window defective Garbage in halls
Electric wiring exposed Building inspection card not
Bedroom Light fixtures or outlets posted
defective Mailboxes broken or mossing
Ceiling falling Drain stoppage Loose steps on stairs
Ceiling fell Faucets broken Banister missing
Ceiling cracked Faucets not installed Windows in halls cracked or
Ceiling leaking Fridge defective, broken broken
Plaster falling Wall tiles cracked or missing Halls need painting
Floors broken or warped Toilet defective or broken Leaks in halls
Walls cracked or bulging Other: Holes in walls, ceiling
Radiators, steam pipes leaking Garbage in basement
Window pane cracked, broken Living Room Lighting in basement poor or
Window defective nonexistent
Electric wiring exposed Ceiling falling Rats, mice, roach infestation
Light fixtures or outlets Ceiling fell Fire escape needs painting
defective Ceiling cracked Roof leaks
Other_________ Ceiling leaking Garbage on roof
Plaster falling Roof door doesn’t shut/latch
Kitchen Floors broken or warped from inside
Walls cracked or bulging Sidewalks cracked or broken
Ceiling falling Radiators, steam pipes leaking Garbage in front of building
Ceiling fell Window pane cracked, broken No super
Ceiling cracked Window defective Boiler broken
Ceiling leaking Electric wiring exposed Gas odor/leak
Plaster falling Light fixtures or outlets Elevator broken
Floors broken or warped defective Graffiti
Walls cracked or bulging Other_________
Radiators, steam pipes leaking
Window pane cracked, broken For entire Apartment: TENANT SIGNATURE:
Window defective
Electric wiring exposed No hot water _________________________
Light fixtures or outlets No cold water
defective No/inadequate heat DATE:
Drain stoppage Apartment door broken
Faucets broken Apartment door lock broken
Faucets not installed Doorbell not working _________________________
Fridge defective, broken Roaches
Other: Mice
Rats
Floors sag
Apartment needs painting