Use this assessment form to evaluate living conditions where squalor or hoarding may pose health and safety risks. Capture site details, access issues, accumulation of refuse and items, cleanliness across floors, walls, bathroom, kitchen and food areas, odors and vermin, and the condition of sleeping areas. Verify essential services such as running water, electricity, gas, and wastewater systems, and note structural safety, asbestos damage, mold, and fire risk. Record health risks to neighbors, document findings, add notes, and determine referrals to child protection, animal welfare, emergency services, or other support agencies.
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