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Printable home checklist
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- hha-home-checklist-v1.pdf3 pages · 90 KB · Version v1
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- hha-home-checklist-v1.docx15 KB · Version v1
Source date October 13, 2026
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US Letter, grayscale-friendly, and legible when scaled to A4. Nothing is pre-filled.
01Purpose, water source/report and air task 
02Four rooms with observation/action lines 
03Task, responsible person, date, completion and official sources
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Page 1: water and air
Date started
- Your answer
- Blank
- Notes
- Blank
Occupancy: owner, renter or other
- Your answer
- Blank
- Notes
- Blank
Water source: public supply, private well, other or unknown
- Your answer
- Blank
- Notes
- Blank
Supplier name or well details
- Your answer
- Blank
- Notes
- Blank
Current supplier report or testing record: have, none or unsure
- Your answer
- Blank
- Notes
- Blank
Where the report or record is kept, and its date
- Your answer
- Blank
- Notes
- Blank
Air task: compare a particle cleaner, understand a monitor, organize maintenance or unsure
- Your answer
- Blank
- Notes
- Blank
Room and its size in feet (length × width × height)
- Your answer
- Blank
- Notes
- Blank
Equipment records: have filter/model instructions, missing or no equipment
- Your answer
- Blank
- Notes
- Blank
Equipment you already have and where its instructions are
- Your answer
- Blank
- Notes
- Blank
Page 2: four rooms
Record only what you can observe safely. Note any moisture signs (active leak, recurring condensation, stain or visible growth, none noticed or unknown), what you observed and the action it needs. “Unknown” is an acceptable entry.
Bedroom
- Moisture signs seen
- Blank
- Observation
- Blank
- Action
- Blank
Kitchen
- Moisture signs seen
- Blank
- Observation
- Blank
- Action
- Blank
Bathroom
- Moisture signs seen
- Blank
- Observation
- Blank
- Action
- Blank
Basement
- Moisture signs seen
- Blank
- Observation
- Blank
- Action
- Blank
Page 3: task list
Row 1
- Task
- Blank
- Responsible person
- Blank
- Date
- Blank
- Completed
- Blank
- Official source
- Blank
Row 2
- Task
- Blank
- Responsible person
- Blank
- Date
- Blank
- Completed
- Blank
- Official source
- Blank
- + 4 more blank rows like these.
License
Personal household use and sharing an unmodified blank copy are allowed with attribution. Commercial resale, removal of attribution and implied certification are not permitted.
Sources and review
Sources show the date they were accessed. A person has not yet recorded a check date for this page.
- EPA: Consumer Confidence Reports, US Environmental Protection Agency (accessed October 13, 2026) — Public-water quality reports and supplier information.
- EPA: private-well water, US Environmental Protection Agency (accessed October 13, 2026) — Routine private-well testing and local guidance.
- EPA: air cleaners in the home, US Environmental Protection Agency (accessed October 13, 2026) — Particle clean-air delivery rate and room fit; EPA does not endorse brands.
- EPA: mold testing or sampling, US Environmental Protection Agency (accessed October 13, 2026) — Visible mold generally does not require sampling; there are no federal airborne mold limits.
- EPA: radon health risk, US Environmental Protection Agency (accessed October 13, 2026) — Use official radon guidance, not a general air monitor as a substitute for appropriate testing.
- Last checked
- Not yet recorded