"Client File Checklist" - Arizona

Client File Checklist is a legal document that was released by the Arizona Department of Housing - a government authority operating within Arizona.

Form Details:

  • Released on November 4, 2019;
  • The latest edition currently provided by the Arizona Department of Housing;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arizona Department of Housing.

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Download "Client File Checklist" - Arizona

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Weatherization Assistance Program
CLEAR FORM
CLIENT FILE CHECKLIST
PRINT FORM
Date:
Subgrantee:
>
ADOH WAP Database #:
Job #:
Client Name:
Client Address:
Owner
Renter
1. ELIGIBILITY – The following are elements related to the eligibility of the unit. These documents may be in
YES
NO
N/A
the file or possibly “on file” depending on the Subgrantee file structure.
 Client Weatherization Application
 Income Calculation Form/Income Eligibility documentation
 Owner/Rental Documents: Proof of Ownership OR Signed Landlord/Tenant Agreement.
 Previous Weatherization Form
 State Historic Preservation (SHPO) documents
 Certification of Zero Income Form
 Utility Release Form
2. CLIENT CORRESPONDENCE & SIGN OFFS – Each file must have clear records of any client interactions
YES
NO
N/A
during the weatherization process.
 Progress Form
 Deferral Information
 Client Rights and Responsibilities
 Household Action Plan
 Refusal for Services Indemnification & Waiver Claim
 Hazard Disclosure Form (Lead, Mold, Radon)
 Client Complaints & Documented Resolution
3. THE WORK – The following are representative of the documentation that provide a complete picture of
YES
NO
N/A
the work performed.
 Client Health and Safety Evaluation Form for auditor.
 Residential Diagnostic Evaluation Form (initial & final audit)
 Scope of Work signed off by client
 Change Orders signed off by client
 Waiver Request Form (REM; H&S)
 Lead Safe Weatherization (LSW) documents. If applicable, relevant photos and record keeping forms.
 Certified Renovator Documentation
 Photos of replaced equipment/HVAC (provide photos of before and after)
 Vendor Bids
 Subgrantee Statement of Completion
 Quality Control Inspection (QCI) Checklist
4. INVOICE – The Subgrantee needs to demonstrate a methodical and consistent ability to pull the
YES
NO
N/A
necessary invoice information by job.
CONTRACTOR BASED
 Related to WAP measures – materials, labor costs.
 Information related to bid/equipment details/specifications.
CREW BASED
 Inventory Sheets
 Installed Materials/Costs
 PO for materials/invoices
FORM INSTRUCTIONS:
COMMENTS:
1. A Subgrantee representative must provide a signature acknowledging that
all items checked on this form are in the client file.
2. This form is mandatory and must be kept in every client file.
SUBGRANTEE SIGNATURE
Revised on 11/04/19
Weatherization Assistance Program
CLEAR FORM
CLIENT FILE CHECKLIST
PRINT FORM
Date:
Subgrantee:
>
ADOH WAP Database #:
Job #:
Client Name:
Client Address:
Owner
Renter
1. ELIGIBILITY – The following are elements related to the eligibility of the unit. These documents may be in
YES
NO
N/A
the file or possibly “on file” depending on the Subgrantee file structure.
 Client Weatherization Application
 Income Calculation Form/Income Eligibility documentation
 Owner/Rental Documents: Proof of Ownership OR Signed Landlord/Tenant Agreement.
 Previous Weatherization Form
 State Historic Preservation (SHPO) documents
 Certification of Zero Income Form
 Utility Release Form
2. CLIENT CORRESPONDENCE & SIGN OFFS – Each file must have clear records of any client interactions
YES
NO
N/A
during the weatherization process.
 Progress Form
 Deferral Information
 Client Rights and Responsibilities
 Household Action Plan
 Refusal for Services Indemnification & Waiver Claim
 Hazard Disclosure Form (Lead, Mold, Radon)
 Client Complaints & Documented Resolution
3. THE WORK – The following are representative of the documentation that provide a complete picture of
YES
NO
N/A
the work performed.
 Client Health and Safety Evaluation Form for auditor.
 Residential Diagnostic Evaluation Form (initial & final audit)
 Scope of Work signed off by client
 Change Orders signed off by client
 Waiver Request Form (REM; H&S)
 Lead Safe Weatherization (LSW) documents. If applicable, relevant photos and record keeping forms.
 Certified Renovator Documentation
 Photos of replaced equipment/HVAC (provide photos of before and after)
 Vendor Bids
 Subgrantee Statement of Completion
 Quality Control Inspection (QCI) Checklist
4. INVOICE – The Subgrantee needs to demonstrate a methodical and consistent ability to pull the
YES
NO
N/A
necessary invoice information by job.
CONTRACTOR BASED
 Related to WAP measures – materials, labor costs.
 Information related to bid/equipment details/specifications.
CREW BASED
 Inventory Sheets
 Installed Materials/Costs
 PO for materials/invoices
FORM INSTRUCTIONS:
COMMENTS:
1. A Subgrantee representative must provide a signature acknowledging that
all items checked on this form are in the client file.
2. This form is mandatory and must be kept in every client file.
SUBGRANTEE SIGNATURE
Revised on 11/04/19