New South Wales Consolidated Regulations(Clause 11 (1))
Retirement Villages Act 1999 , section 38
Address of residential premises:
Date of inspection:
1 The operator, or an agent or employee of the operator, must inspect the premises and complete this report in accordance with these directions.
2 The report is to be completed in the presence of the prospective resident (or a person nominated by the prospective resident) before the operator and the prospective resident enter into a village contract.
3 However, if the premises are still being constructed, the operator and the prospective resident may enter a village contract before this report is completed, but the report must be otherwise completed in accordance with these directions before the prospective resident occupies the premises.
4 The report must be completed to the best of the operator’s knowledge (or, if the inspection is carried out by an agent or employee of the operator, to the best of that agent’s or employee’s knowledge).
5 If a required date is not known, an approximate date must be given and identified as such.
6 Sufficient time must be allowed for the prospective resident (or the prospective resident’s nominee) to examine the report and suggest changes to it.
7 The report must be signed by the operator (or, if the inspection is carried out by an agent or employee of the operator, by that agent or employee). The prospective resident (or the prospective resident’s nominee) must also sign the report if he or she agrees with it.
8 A copy of the condition report must be annexed to the first village contract that the prospective resident enters into with the operator.
Are the premises generally clean and free of rubbish?
Yes/No
If No, specify
Are there any signs of fleas, cockroaches, ants or other pests in the
premises? Yes/No
If Yes, specify
Are the premises carpeted? Yes/No
If Yes, has the carpet in the premises been newly laid? Yes/No
If No, the carpet was originally laid in
Is the carpet generally clean? Yes/No
Are there any stains, burns or other marks on the carpet? Yes/No
If Yes, specify
Are any other floor coverings (eg tiles, vinyl) damaged in any way? Yes/No
If Yes, specify
Have the internal walls of the premises been freshly painted? Yes/No
If No, the walls were last painted in
Are there any picture hooks on the walls? Yes/No
If Yes, how many?
Are there any cracks, holes, scratches, signs of mould, rising damp or other
marks on the walls? Yes/No
If Yes, specify
Are the windows of the premises clean? Yes/No
Are blinds/curtains provided with the premises? Yes/No
If Yes, how many?
Are blinds/curtains new? Yes/No
If No, the blinds/curtains were installed in
Are the blinds/curtains clean, free of dust and undamaged? Yes/No
If No, specify
Are flyscreens provided with the premises? Yes/No
If Yes, how many?
Are the flyscreens damaged in any way? Yes/No
If Yes, specify
Are light fittings provided with the premises? Yes/No
If Yes, how many?
Are the light fittings clean, free of dust and undamaged? Yes/No
If No, specify
(delete if the premises does not have a kitchen)
Has the kitchen in the premises been newly installed or renovated? Yes/No
If No, the kitchen was originally installed in
The kitchen contains the following appliances: (delete those not applicable)
stove/wall oven/hot plates/refrigerator/dishwasher/range hood/microwave/other
(specify)
Are all the appliances listed above in working order? Yes/No
If No, specify
Is the kitchen generally clean? Yes/No
If No, specify
Are there any scratches, burns or other marks on the bench tops, sink or
appliances listed above? Yes/No
If Yes, specify
Has the bathroom in the premises been newly installed or renovated?
Yes/No
If No, the bathroom was originally installed in
The bathroom contains the following fixtures: (delete those not applicable)
bath/shower/shower screen/toilet/wash
basin/vanity/cupboard/cabinet/mirror/grab rails/shower seat/hand held shower
hose/other
(specify)
Is the bathroom generally clean? Yes/No
If No, specify
Are there any chips, scratches or other marks on any of the bathroom fixtures?
Yes/No
If Yes, specify
Are all the locks on the premises in working order? Yes/No
If No, specify
Keys for the following locks will be provided by the operator: (delete those
not applicable) front door/security door/back door/letterbox/window
locks/garage/storeroom/other
(specify)
Are smoke alarms installed on the premises? Yes/No
Are all smoke alarms on the premises in working order? Yes/No
If No, specify
Is electricity available to be connected by the resident? Yes/No
Will the resident be separately billed by the supply authority for electricity
charges relating to the premises? Yes/No
If Yes, the electricity meter reading is
Is gas available to be connected by the resident? Yes/No
Will the resident be separately billed by the supply authority for gas charges
relating to the premises? Yes/No
If Yes, the gas meter reading is
Will the resident be separately billed by the supply authority for water usage
charges relating to the premises? Yes/No
If Yes, the water meter reading is
Is there a telephone line installed in the premises available to be connected
by the resident? Yes/No
(delete if no garage/carport is provided with the premises)
Is the garage/carport generally clean and free of rubbish? Yes/No
If No, specify
Are there any grease stains on the floor of the garage/carport or driveway?
Yes/No
If Yes, specify
(delete if no storeroom is provided with the premises)
Is the storeroom empty, generally clean and free of rubbish? Yes/No
If No, specify
(delete if no garden is provided with the premises)
Is the garden generally clean and free of rubbish? Yes/No
If No, specify
Has the lawn area been recently mown? Yes/No
List all other fixtures, fittings, furniture or household items supplied with the premises not mentioned elsewhere in this report:
| item | age of item | condition of item |
Has the operator undertaken to do any improvements/repairs to the premises? Yes/No
| work to be undertaken | estimated completion date |
Signed by or on behalf of the operator:
(print name)(signature)
Date://
Note: The prospective resident, or the prospective resident’s nominee, should not sign this report if they do not agree with it.
Signed by or on
behalf of the prospective resident:
(print name)(signature)
Date://