Unsafe living conditions

EMERGENCY RENTAL ASSISTANCE PROGRAM (ERAP)

Unsafe Living Conditions Policy

These are items that would be considered unsafe HOWEVER, you must first report these items to a landlord and give the landlord time to correct before you can state that you are living in an unsafe condition.

Name

First NameLast Name

Please list the date that this list was given to the landlord

Date

Please check if a violation exists and get landlord signature to complete the form in order to use this reason for ERAP eligibility:

Heat is working improperly or not at allNo electricity or gas supplyInadequate or insufficient electrical outlets or lighting in common areasUnsafe or no water supplyNo working toilet or sewage disposal systemInadequate exits or obstruction of exitsInadequate or lack of locks for entry doorsAccumulation of garbage or filth that may provide food or shelter for rodents, insectsLead paint that a child under 6 can reach

Tenant signature

Clear

Landlord signature

Clear

Landlord contact information