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    HSC House Visit Form

    Uploaded by

    Kimberly Marie Sousa
    This document is an evaluation form used by the Housing Service Committee to conduct house visits of Oxford Houses of Virginia. It collects information about the house such as contact details, number of beds and members, house officers, rent payment status, house finances, and procedures. It assesses the house meeting, record keeping, safety equipment, and relationships with local agencies. The form is reviewed at monthly chapter meetings and proposed solutions are discussed.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    HSC House Visit Form

    Uploaded by

    Kimberly Marie Sousa
    118 views5 pages
    This document is an evaluation form used by the Housing Service Committee to conduct house visits of Oxford Houses of Virginia. It collects information about the house such as contact details, number of beds and members, house officers, rent payment status, house finances, and procedures. It assesses the house meeting, record keeping, safety equipment, and relationships with local agencies. The form is reviewed at monthly chapter meetings and proposed solutions are discussed.

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    This document is an evaluation form used by the Housing Service Committee to conduct house visits of Oxford Houses of Virginia. It collects information about the house such as contact details, number of beds and members, house officers, rent payment status, house finances, and procedures. It assesses the house meeting, record keeping, safety equipment, and relationships with local agencies. The form is reviewed at monthly chapter meetings and proposed solutions are discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    118 views5 pages

    HSC House Visit Form

    Uploaded by

    Kimberly Marie Sousa
    This document is an evaluation form used by the Housing Service Committee to conduct house visits of Oxford Houses of Virginia. It collects information about the house such as contact details, number of beds and members, house officers, rent payment status, house finances, and procedures. It assesses the house meeting, record keeping, safety equipment, and relationships with local agencies. The form is reviewed at monthly chapter meetings and proposed solutions are discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 5

    OXFORD HOUSES OF VIRGINIA

    HOUSE VISIT EVALUATION FORM


    HOUSING SERVICE COMMITTEE HOUSE VISIT

    THIS REPORT IS TO BE REVIEWED AT MONTHLY CHAPTER MEETING

    RATING SCALE

    1-Excellent 2-Good 3-Satisfactory 4-Fair 5-Unsatisfactory

    NAME OF HOUSE: _________________________________ PHONE: _________________

    HOUSE ADDRESS: ______________________________________________________

    # OF BEDS: __________ # OF BEDROOMS______ # OF MEMBERS: __________

    NAMES OF HOUSE OFFICERS: NAME ELECTED


    PRESIDENT
    SECRETARY
    TREASURER
    COMPTROLLER
    CHORE COORDINATOR
    HSC REPRESENTATIVE
    HSC REPRESENTATIVE
    ALTERNATE

    OVERALL APPEARANCE OF THE HOUSE: ________________________________________


    [IS THE HOUSE CLEAN, DUSTED, GENERALLY WELL MAINTAINED, COMMON AREAS, KITCHEN, YARD, OUTSIDE]

    ________________________________________________________________________

    ________________________________________________________________________

    HOUSE MEMBERS RENT STATUS: [LIST MEMBERS IN ARREARS & AMOUNT]

    MEMBER & AMOUNT: _____________________________

    MEMBER & AMOUNT: _____________________________

    MEMBER & AMOUNT: _____________________________

    [LIST MEMBERS PAID AHEAD A WEEK OR MORE]

    MEMBER & AMOUNT: _____________________________

    MEMBER & AMOUNT: _____________________________

    HSC HOUSE VISIT FORM-VERSION MARCH 2010 Page 1 of 5


    OXFORD HOUSES OF VIRGINIA
    HOUSE VISIT EVALUATION FORM
    HOUSING SERVICE COMMITTEE HOUSE VISIT

    AMOUNT OF MONTHLY RENT PAID TO LANDLORD: __________________

    AMOUNT OF CURRENT WEEKLY EES PAID BY MEMBERS: ______________________

    ESTIMATED UTILITY COST PER MONTH: ___________________________

    STATUS OF HOUSE BILLS:

    ARE ALL HOUSE BILLS CURRENT [Y/N] ___________? IF NOT, LIST BILLS & AMOUNT DUE &
    REASON FOR ARREARS:

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    HOUSE BUSINESS MEETING:


    [USE 1-5 SCALE]

    1. READING OF TRADITIONS & RULES AT HOUSE MEETING:_______

    2. PRESENTATION OF TREASURER’S REPORT:__________

    3. PRESENTATION OF COMPTROLLER’S REPORT:________

    4. PRESENTATION OF COORDINATOR’S REPORT:________

    5. PRESENTATION OF SECRETARY’S REPORT:___________

    6. ADHERANCE TO TRADITION GUIDELINES:____________

    7. HANDLING OF HOUSE BUSINESS/ISSUES:_____________

    8. HOUSE MEMBER’S ATTENDANCE AT MEETING:________

    HSC HOUSE VISIT FORM-VERSION MARCH 2010 Page 2 of 5


    OXFORD HOUSES OF VIRGINIA
    HOUSE VISIT EVALUATION FORM
    HOUSING SERVICE COMMITTEE HOUSE VISIT

    ARE HOUSE OFFICERS ELECTED EVERY 6 MONTHS [Y/N]? ______________

    DO THE PRESIDENT, TREASURER & COMPTROLLER COMPLETE THE MONTHLY AUDIT USING THE
    PROPER FORM [Y/N]? _____________ [ASK TO REVIEW MOST RECENT AUDIT]

    IS THE HOUSE CHECKBOOK PROPERLY SECURED [Y/N]? _________

    IS ACCESS TO THE HOUSE CHECKBOOK CONTROLLED BY A HOUSE MEMBER WHO DOES NOT
    HAVE SIGNATURE AUTHORITY ON THE HOUSE CHECKING ACCOUNT [Y/N]? _____________

    ARE THE MONEY ORDERS & RECEIPTS PASSED AROUND DURING THE TREASURER’S REPORT AT
    THE HOUSE MEETING [Y/N]? _______________

    DOES THE HOUSE SHOW THE 60 MINUTES VIDEO DURING THE INTERVIEW PROCESS [Y/N]
    ______?

    DOES THE HOUSE HAVE CURRENT INTERVIEW QUESTIONS [Y/N]? _____________

    DOES THE HOUSE HAVE NEW MEMBER PACKETS {Y/N]? _____________

    DOES THE HOUSE HAVE A PROCEDURE TO WELCOME NEW MEMBERS? [EXPLAIN HOUSE
    GUIDELINES/ RULES, CUPBOARD SPACE, REFRIGERATOR SPACE, ETC.] Y/N: _______________

    GENERAL IMPRESSION OF HOUSE MEETING: [ATTENDANCE, ALLOWING ADEQUATE TIME FOR


    DISCUSSION ON ISSUES, DEMOCRATIC PROCESS, FEELINGS CHECK, ETC.]

    ____________________________________________________________________________

    ____________________________________________________________________________

    ____________________________________________________________________________

    HSC HOUSE VISIT FORM-VERSION MARCH 2010 Page 3 of 5


    OXFORD HOUSES OF VIRGINIA
    HOUSE VISIT EVALUATION FORM
    HOUSING SERVICE COMMITTEE HOUSE VISIT

    IS THE CHECKBOOK BALANCED AGAINST THE BANK STATEMENT [Y/N]? _____________

    DOES THE HOUSE USE THE CURRENT OXFORD HOUSE FORMS [Y/N]? ___________
    [DOES THE HOUSE NEED ANY FORMS?]

    DOES THE HOUSE HAVE AN APPROPRIATE NUMBER OF SMOKE DETECTORS [Y/N]? __________

    FIRE EXTINGUISHERS [Y/N]? __________ CARBON MONOXIDE MONITORS [Y/N]? _______

    ASK FOR A COPY OF CURRENT HOUSE RULES/BYLAWS & LEASE AGREEMENT

    NAME OF LANDLORD/PROPERTY MANAGEMENT FIRM, ADDRESS & PHONE NUMBER:

    _____________________________________________________________________

    _____________________________________________________________________

    WHAT IS THE HOUSE POLICY FOR DEALING WITH PHONE CALLS FOR INTERVIEWS WHEN THE
    HOUSE IS FULL?

    _______________________________________________________________________

    _______________________________________________________________________

    _______________________________________________________________________

    DOES THE HOUSE HAVE CONTACTS AT LOCAL COMMUNITY REFERRAL AGENCIES [e.g.
    COMMUNITY SERVICES BOARDS, TREATMENT CENTERS, DETOX CENTERS, PROBATION &
    PAROLE OFFICES AND OTHER REFERRAL AGENCIES]? WHO IS THE CONTACT? IS THERE A
    DESIGNATED PERSON RESPONSIBLE FOR CONTACTING THESE AGENCIES? IF SO, WHO?

    _________________________________________________________________________

    _________________________________________________________________________

    _________________________________________________________________________

    _________________________________________________________________________

    _________________________________________________________________________

    HSC HOUSE VISIT FORM-VERSION MARCH 2010 Page 4 of 5


    OXFORD HOUSES OF VIRGINIA
    HOUSE VISIT EVALUATION FORM
    HOUSING SERVICE COMMITTEE HOUSE VISIT

    DOES THE HOUSE HAVE ANY COMPLAINTS? WHAT COULD THE CHAPTER DO BETTER FOR THE
    HOUSE?

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    PROPOSED SOLUTIONS/SUGGESTIONS:

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________ ______________________________
    HOUSING SERVICE REP HOUSING SERVICE REP

    ________________________________ ______________________________
    HOUSING SERVICE REP HOUSING SERVICE REP

    ________________________________ ______________________________
    HOUSING SERVICE REP HOUSING SERVICE REP

    DATE OF VISIT:_____________________ FOLLOW-UP VISIT DATE:___________

    HSC HOUSE VISIT FORM-VERSION MARCH 2010 Page 5 of 5

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