The common housing register.pmd - Gravesham Borough Council

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Gravesham Borough Council The Common Housing Register application form May 2004 3. Type of accommodation Property type: House Flat Other Maisonette Bungalow please specify Number of rooms Bedrooms Living rooms Kitchens Bathrooms Toilets Other rooms Used by you and your immediate family total number of rooms in the property Is the property let as seperate flats? Yes No If yes, please state number of flats If you live in a flat on what level is it situated? Please state: Basement, ground, 1st floor etc. How many stairs/steps are there to your front door? How many internal stairs are there to the toilet? Do you have access to a lift? Yes No 4. Internal facilities Please confirm whether you have the following facilities: Yes/No Shared with other people besides your household Kitchen Fixed bath or shower Internal toilet Fixed heating in at least one room Cold water supply Hot water supply Lounge What type of heating do you have? Do you have any serious repair problems with your accommodation? Yes No Please give details 6 If you have any serious repair problems we may refer you to a section of the council or another organisation that may be able to help.
Gravesham Borough Council The Common Housing Register application form May 2004 Details of other people living at this address (do not include those shown in question 1 above) Name if known Date of birth Male/Female Relationship to applicant (if none please state ‘None’) Medical factors Please give details of any medical factors, mental or physical, affecting you, or a member of your family, which you feel would be improved or assisted by moving. Is the person or persons reffered to above, on any long-term medication which relates to their housing application? Yes No If yes, please state the name and the dosage. Has the medical condition reffered to above resulted in an overnight stay in hosptial during the past twelve months? Yes No If yes, please give date(s) and name of hospital. Name and address of GP Name and address of Specialist/consultant if applicable Name and address of Social Worker/Care Manager/CPN/Occupational therapist if applicable Have any adaptations been carried out to make your home suitable for a disabled person in your household? Yes No If yes, please give details. 7
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The common housing register.pmd - Gravesham Borough Council

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