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ATTACHMENT A
VA Tennessee Valley Healthcare System
Hotel Inspection Environmental Health and Water Intrusion Check List *
| Inspection Performed By: |
| Yes No NA |
Potential Water Intrusion Evidence
| 1 |
| Leaks and/or cracks around windows and doors (check corners of the frames both interior and exterior) |
| 2 |
| Evident of Peeling paint on windows and door frames |
| 3 |
| Discoloration in paint around doors and windows due to rust, water stains etc.? |
| 4 |
| Are there Cracked or deteriorated caulking around the windows or door frames? |
| 5 |
| Cracks or holes in the external walls and foundation that could allow outside water into or under the building? |
| 6 |
| Does outside surface drain away from or toward the building? |
| 7 |
| Are there water Stained ceilings or missing tiles or walls or ceiling with cracks? |
| 8 |
| Is Vinyl wallpaper on exterior walls or where air conditions units would blow chill air on the vinyl? |
| 19 |
| Any evidence of water staining on carpet around the impression of furniture |
| 10 |
| Are there Penetrations (holes) on the walls, floors, or ceilings? |
| 11 |
| Any evidence of wet carpet, walls, floors, ceiling > 15% moisture? |
VA Tennessee Valley Healthcare System
Hotel Inspection Environmental Health and Water Intrusion Check List *
| Inspection Performed By: |
| Yes No NA |
| 12 |
| Does facility Low sloping or flat roof without proper drainage |
| 13 |
| Is there any missing shingles or other evidence of damage to roof? |
| 14 |
| Check for termite- damaged materials such as wood materials that could expose the exterior and can lead to moisture intrusion |
| 15 |
| Check air conditioning units within or next to exterior walls for evidence of moisture intrusion issue |
| 16 |
| Is there water on the exhaust and supply vents or evidence of past elevated moisture issues such as rust? |
| 17 |
| Is there any evidence of leaking pipes or faucets in rooms/ common areas? |
| 18 |
| Is there evidence of plumbing drainage or overflow issues? |
| 19 |
| Is there obvious sanitation or insect issues? |
| 20 |
| Were and musty or mold related odors detected? |
| 21 |
| Were any public safety issues noted? |
*To be completed Quarterly
