CTRC Fact Sheet Index

TenantNet note: These Fact Sheets were published by CTRC in the mid-1990's. Some information will be out-of-date. As far as we know, there have been no updates to these fact sheets. While much of the information may still be valid, the reader should exercise caution.

CTRC Fact Sheets -- reproduced with permission.
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The Community Training Resource Center (CTRC) is a city-wide not-
for-profit organization that champions the rights of modest and
low-income tenants and promotes the preservation, improvement,
and expansion of affordable housing. CTRC provides training and
technical assistance for neighborhood housing groups, community
based organizations, legislative staffs and social service
providers.

CTRC produces fact sheets on tenants' rights, develops and
publishes research reports, and provides a written guide to New
York City government processes. CTRC advocates on budget policies
that affect housing and related services in low-income
neighborhoods. CTRC has led the campaign for the improvement and
expansion of the city's Housing Maintenance Code inspection and
enforcement services.
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CTRC Fact Sheet #200

GENERAL COMPLAINT FORM

INSTRUCTIONS: Place an "x" by the condition in your apartment or
building you wish to identify, and also check off any specifics
relating to the condition following it, if applicable. Identify
specific room where condition exists. Use blank lines for items
not on the list.


(Type or print)

Owner, Agent, or Lessee _________________________________________

Address _________________________________________________________

City/Zip ________________________________________________________

Phone ___________________________________________________________

Tenant __________________________________________________________

Address/Apt _____________________________________________________

City/Zip ________________________________________________________

Phone ___________________________________________________________

Current monthly rent is $_________________

Date tenant moved in: ____________________

No. of rooms in apt: _____________________

Bedroom                                 BR1       BR2    BR3

( )  Ceiling falling                    ( )       ( )    ( )
( )  Ceiling fell                       ( )       ( )    ( )
( )  Floors broken or warped            ( )       ( )    ( )
( )  Radiators, steam pipes leaking     ( )       ( )    ( )
( )  Walls cracked, bulging             ( )       ( )    ( )
( )  Window glass cracked, broken       ( )       ( )    ( )
( )  Window defective                   ( )       ( )    ( )
( )  Electric wiring exposed            ( )       ( )    ( )
( )  Light fixture, outlets defective   ( )       ( )    ( )
( )  Plaster falling                    ( )       ( )    ( )
( )  Other:                             ( )       ( )    ( )


Kitchen

( )  Pipes leak
( )  Ceiling leaks
( )  Ceiling falling
( )  Ceiling fell
( )  Cracks, bulges in walls
( )  Plaster falling
( )  Drain stoppage
( )  Faucets don't work
( )  Faucets not installed
( )  Inadequate water pressure
( )  Window glass cracked, broken
( )  Window defective
( )  Outlets, light fixtures defective
( )  Electric wiring exposed
( )  Refrigerator defective, broken
( )  Stove defective, broken
( )  Floor warped or broken
( )  Other: _______________________________________________


Bathroom

( )  Pipes, fixtures leak
( )  Ceiling leaks
( )  Ceiling falling
( )  Ceiling fell
( )  Cracks, bulges in walls
( )  Plaster falling
( )  Toilet obstructed
( )  Flushometer defective or broken
( )  Bathtub/Shower defective
( )  Inadequate water pressure
( )  Window glass cracked/broken
( )  Window defective
( )  Light fixture outlet defective
( )  Floor tiles cracked or missing
( )  Wall tiles cracked or missing
( )  Door broken
( )  Door lock defective
( )  Electric wiring exposed
( )  Other: _______________________________________________


Living Room

( )  Holes
( )  Ceiling leaks
( )  Ceiling falling
( )  Ceiling fell
( )  Floors warped or broken
( )  Window glass cracked or broken
( )  Window defective
( )  Electric wiring exposed
( )  Light fixtures, outlets defective
( )  Cracks, bulges in walls
( )  Plaster falling
( )  Radiators, steam pipes leaking
( )  Other: _______________________________________________


For Entire Apartment

( )  Doorbell does not work
( )  Roaches
( )  Mice
( )  Rats
( )  Floor sags
( )  No hot water
( )  No cold water
( )  No heat
( )  Inadequate heat
( )  Apartment needs painting. Date of last paint _______
( )  Cracks in walls, ceilings
( )  Apartment door broken
( )  Door frame broken
( )  Apartment door lock defective
( )  No lock on apartment door
( )  Other: _______________________________________________


Public Areas and Building Grounds

( )  Inadequate lighting in halls and stairways
( )  Bells/buzzers do not work
( )  Entrance door broken
( )  No entrance door
( )  Entrance door lock defective
( )  No lock
( )  Hole in entrance door
( )  Entrance door not self closing
( )  Garbage in vestibule and hallways
( )  Vestibule or hallways dirty
( )  Building inspection card is not posted
( )  Mailbox(es) broken or missing
( )  Loose steps on stairs
( )  Broken/missing steps in stairwell
( )  Hallway walls needs painting
( )  Banister loose
( )  Banister missing
( )  Holes in walls, ceiling
( )  Leaks in halls
( )  Plaster falling
( )  Garbage in basement
( )  Leaks, flooding in basement
( )  Rats, mice, or roaches throughout building
( )  Fire escape defective
( )  Fire escape needs painting
( )  Roof leaks
( )  Hole in roof, skylight
( )  Defective gutter
( )  Garbage on roof
( )  Roof door does not latch from inside
( )  Roof door defective, broken
( )  Roof door missing
( )  Sidewalks cracked/broken
( )  Garbage in front of building
( )  No superintendent
( )  Boiler broken
( )  Boiler defective
( )  Gas odor/leak
( )  Boiler smokes/smells
( )  Elevator defective
( )  Elevator out or order
( )  Elevator inspection card missing
( )  Backyard dirty
( )  Garbage in yard
( )  No lighting in vestibule/hallways
( )  Lighting poor, defective or non-existent in basement
( )  Rent receipt not given
( )  Rent receipt does not show an address for landlord
( )  Windows in hallways cracked, broken, or missing


Tenant's signature ___________________________________________

(Must be signed if submitted to NYC Division of Code Enforcement
as a complaint)


                               ###

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These article are Copyright 1995 and 1996 by Community Training Resource
Center (CTRC) and reproduced by TenantNet. They may be freely
redistributed in their entirety provided they are reproduced exactly
as in the originals, including this copyright notice, the opening and
closing informational banners and any references to either CTRC
or TenantNet must be included.

These article are provided as is without any express or implied
warranty. While any information in these article is believed to be
correct at the time of writing, these articles are for educational
purposes only and do not purport to provide legal advice. If
you require legal advice, you should consult with a legal
practitioner licensed to practice in your jurisdiction.

Community Training Resource Center                (212)964-7200
47 Ann Street
New York, NY 10038

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