CLARK HALL ROOM CONDITION REPORT
It is my responsibility to take care of my room and to report maintenance needs as they occur;
All costs for damages will be shared equally by my roommate(s) and me unless otherwise agreed upon by the individual(s)
responsible for the damages;
It is my responsibility to notify my Resident Assistant if changes in my room condition occur before I check out;
It is my responsibility to complete proper check out procedures when I move out of my room.
There may be further charges related to my room upon completion of a final room inspection by my Residence Coordinator
By not submitting an RCR, I forfeit my right to appeal any charges resulting from damage.
______________________
________________
ID NUMBER
______________
DATE
_________________________________
CELL PHONE NUMBER
How to Fill Out This RCR:
Before moving your items into the room, please take time to examine the condition of
all the items in the room and note their condition in the appropriate area on pages 2
and 3 of this document:
Room #________________________
Left/Right/Center Room (If Applicable)______________
1. Open and close all the drawers on the desks and dressers in the space.
2. Open and close the room door, inspecting for damages to the knob, lock or peephole.
3. Look inside the closet, examining the walls for damages, graffiti, etc.
4. Open and close each window, examining the closing of the window as well as the
condition of the screen, the window, the drapes/blinds.
5. Turn on and off each light switch in the room space, inspecting for light bulbs being out or missing, as well as examining the light switch faceplate for cracks or
damage.
6. Examine all room outlets, including electrical, cable and data jacks and Ethernet
Ports, for damages to faceplates, hanging wires, etc.
7. Examine the shelves in the room.
8. Using the diagram on pages 2 and 3 of this document, please examine the Walls
(A/B/C/D) and illustrate any damages or marks that you may see.
9. Examine the bed—mattress and frame—for any damages.
10. Examine the ceiling for any cracks, water marks or damages to the surface.
11. Please make sure that each room’s smoke detector is installed.
12. Examine the mirror and sinks in the room for any cracks and chips and note any
damages on this document in the appropriate area.
13. Failure to check-out, or failure to check-out properly, will result in an automatic
fine.
Triple
Please fill out ALL the relevant portions of this document in either blue or black pen,
NO PENCIL PLEASE. Please sign and date this document as required and provide
your Student ID Number (above), and your hall name and room number (right).
Failure to do so may result in future damage billing charges upon checkout.
Double
STUDENT SIGNATURE
Single
I have inspected my room and have made any necessary notes on this RCR to accurately reflect the
condition of my room. I recognize that I may be billed upon move out for the cost of repair to any item
in my room and that this RCR will be the basis for damage billing.
Student’s Name _____________________________________________
The University of Dallas considers the room to be in like new condition unless otherwise indicated on this RCR
and verified by Residential Life staff. If this RCR is not returned to your RA by 5pm on the first Friday after the first day of
classes (or three days after moving in), I agree that the room/suite is in like new condition. I understand that:
Type of Room (circle)
ROOM CONDITION STATEMENT OF RESPONSIBILITY
As you check-in it is important for you to complete and sign this room condition report (RCR). You should record on this RCR
are any pre-existing damages in your room. When you check-out of your room, any damage which is not recorded on this RCR
and which is identified by a student affairs staff member during a final room inspection will be billed to your student account.
Window / Wall A
COMMON ROOM
Use this page to document any damages to the common room, if
applicable. If you are in a single or double, continue to page 3.
Floors
In the space provided, please illustrate/draw any
heavy scratching or damage.
Be as detailed as possible.
Wall
D
Wall
B
Door / Wall C
Check-Out Notes:
Check-In Notes:
Walls
In the space provided, please illustrate/draw any marks, paint chips, writing, etc. on the walls. In every residence hall room, Wall A is the
wall with the window. Clockwise from wall A is wall B, and so on. Write any details or addi-tional notes in the space provided. If your room
has an entryway or does not fit this layout, modify the spaces below and be sure to note the condition of those walls as well. Be as detailed
as possible.
Check-In Notes:
Wall A (window)
Wall B
Wall C
Wall D
Check-Out Notes:
Window / Wall A
PERSONAL ROOM
Use this page to document any damages to the common room,
if applicable.
Floors
In the space provided, please illustrate/draw any
heavy scratching or damage.
Be as detailed as possible.
Wall
D
Wall
B
Door / Wall C
Check-Out Notes:
Check-In Notes:
Walls
In the space provided, please illustrate/draw any marks, paint chips, writing, etc. on the walls. In every residence hall room, Wall A is the
wall facing you when you walk in, and is usually the wall with windows. Clockwise from wall A is wall B, and so on. Write any details or additional notes in the space provided. If your room has an entryway or does not fit this layout, modify the spaces below and be sure to note the
condition of those walls as well. Be as detailed as possible.
Check-In Notes:
Wall A (window)
Wall B
Wall C (Door)
Wall D
Check-Out Notes:
Items
# of
Items
Check-In Condition / Notes
Check-Out Condition / Notes
Wooden Frame
Bed
Mattress
Metal Spring
Desk
Desk
Hutch/Bookshelf
Chair
Dresser
Drawer(s)/ Surface(s)
Outside
Room #/ Plate
Door
Knob / Lock
Inside
Peephole
Wall(s) (L & R)
Closet
Hanging Bar
(if applicable)
Shelf
Glass
Window
Blind(s)
Screens
Light Fixture(s)
Lights
Light Switch
Couch
Coffee Table
Floor (chipped or
damaged tiles/carpet)
Misc.
Data / Cable Jack(s)
Smoke Detector
AC/Heater
Sink
Mirror
Bathroom Shower Bar
INSPECTION CODES:
MR: Maintenance Request
SD: Student damage
Walls (A/B/C/D)
Sink
Key Return
Floors damaged or dirty, $20 minimum
Clean of stains, marks, smudges, tape marks. No damage
such as paint chips, patches, tears, holes
Sink left dirty, $15 minimum
Failure to return room key to the Office of
Student Affairs, $25
TOTAL BILL
Resident
Responsible:
Y, N, or N/A
$25 + Any addtn’l
contract charges
CHARGE
CODE(S)
Check-out Inspection Summary
EXPECTATION OF CONDITION UPON CHECKOUT
Floors
Present and free of obvious tears and holes;
missing screen, $125 minimum
Facilities charges a minimum of $30 per room for any
cleaning done subsequent to resident vacancy of room.
Window Screen
Clean of holes, marks, gouges, stains, residue, etc.
No damage such as paint chips, patches, tears, holes, etc.
Excessive
Cleaning
Ceiling
You will be charged the replacement cost of the furniture.
Any/all personal belongings left in the room following
checkout will be removed. Removal will be charged
to residents. $25/minimum to remove items
Damaged or
missing furniture
Failure to follow check-out instructions, $50
Personal
Belongings
Improper Check-out
Failure to check out on time will result in $25/hour the
student is late
SD: Student damage
Late Check-out
Date of Inspection:
Student Name:ame:
Staff’s Name:
CODES
MR: Maintenance Request
***For Staff Use Only
WORK REQUEST
DATE/TIME OF SUBMISSION