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Housing Safety and Accessibility Forms

Accessibility Standards and Checklist (Pre-Inspection) - The Accessibility Standards and Checklist is used by the agencies for the pre-inspection of a home, prior to contacting the DAIL Home Contractor to schedule a Accessibility Assessment.  (See the Housing Safety and Accessibility Review Protocol.) 

Apartment or Other Alternative Living Arrangement in a Shared Living Providers Home (Fillable Form) - This form is to be used for any situation that is not considered ‘standard’ in a Shared Living Providers home.  (Example:  Apartment, or apartment-like situation in the home or in a building near the home.)  This information will help ensure the living situation meets the federal requirements for shared living, and will enable DAIL to assist agencies and the housing contractor with the DAIL housing process for these homes.  The form is to be filled out and sent to DAIL at AHS.DAILHousingPortal@Vermont.gov before any information is entered into the Housing Portal and before the Housing Contractor is contacted to schedule the inspection.

Chimney Cleaning and Inspection by Non-Professional form - This form is available for the agencies to use for chimney cleaning and inspections that are completed in the years in between the required Professional chimney cleaning and inspections, which may be required during a Home Safety Assessment. (See the Housing Safety and Accessibility Review Protocol.)    

DAIL Housing Assessment Request Form - This form is required to be filled out and e-mailed to the DAIL Housing Contractor when requesting an Assessment to be scheduled.

Fire Safety Escape Plan - The Housing Fire Safety Escape Plan is a requirement of Home and DAIL funded shared living homes. The plan helps all individuals in a shared living home know how to quickly and safely exit the home in case of an emergency, as independently as possible.  It is required to be posted in the home and practiced regularly. The Fire Safety Plan is required to have a graphic version of the plan as well as a written plan, and is required to be uploaded into the DAIL Housing Portal. (See DAIL Inspection Application User Manual for Service Coordinators)

Housing Standards and Checklist (Pre-Inspection) - The Housing Standards and Checklist is used by the agencies for the pre-inspection of a home, prior to contacting the DAIL Home Contractor to schedule a Home Safety Assessment.  (See the Housing Safety and Accessibility Review Protocol.)  The filled out Pre-Inspection form is required to be uploaded into the DAIL Housing Portal. (See DAIL Inspection Application User Manual for Service Coordinators)