Sample Check-In/Check-Out Form
Sample Check-In/Check-Out Form
This is similar to an overall inspection form. However, it will focus only on items in a brother’s particular room. The brother and the Director of House Operations should use the same form, with signatures indicating the agreed-upon condition of the room. At the end of each term, or minimally year, the form will be updated and reviewed. This will ensure that it is easy to note any changes in the room accordingly and assess any fines or damage bills as may be required.
Please Print
Tenant
Parents’ Names
Permanent Address
City State ZIP
Home Phone Work Phone
Email Address Cell Phone
Room Room Lease Signed? Yes No
Damage Deposit Amount for Current Lease $
Room Inspection
Move-In Date: Move-Out Date:
|Bedroom |Move-In |Move-Out |
|Item |Condition |Condition |
|Door(s) & Key(s) | | |
|Door Stop | | |
|Closet & Door | | |
|Light Fixture & Bulb | | |
|Switches & Plugs | | |
|Carpet/Flooring | | |
|Walls | | |
|Ceiling | | |
|Windows | | |
|Screens | | |
|Window Coverings | | |
|Window Sills | | |
|Phone/Internet Jacks | | |
|Plumbing Fixtures | | |
|Cleanliness | | |
|Desk | | |
|Other | | |
| | | |
| | | |
Deposit Calculation
Past Deposit Balance Carried Forward $
Remaining Due for Current Lease $
Additional Charges $
Total Balance Due $
Deposit Paid in Full? Yes No Date Paid
Total Charged for Damages and Cleaning $
Amount to Return to or Collect from Tenant $
Paid Amount in Full? Yes No
Amount has been Returned? Yes No
Move-In
Director of House Operations Date
Tenant Signature Date
Move-Out
Director of House Operations Date
Tenant Signature Date
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