Tenant Inspection Form

Today's Date (mm/dd/yyyy)*

Address*

Street Address Address Line 2 City ZIP Code

NOTE: Tenant inspection requests are only accepted for rental dwelling units within the City of Champaign municipal limits. Rental dwelling units located outside Champaign's city limits should be directed to the government body where the rental unit is located.

Name*

First Last

Phone Number*

Email Address

Please submit an email address if you wish to receive confirmation of your request.

Preferred method of contact*

How long have you lived at this address?*

Do you have a written lease or rental agreement?*

Yes
No

How long have you been aware of the problem(s)?*

Have you informed the landlord, owner or property manager of this complaint?*

Yes
No

If so, whom did you speak with and when?*

Property Owner's Name*

First Last

Property Owner's Phone Number*

Please describe the problem*

Digital Signature*

By checking this box I affirm I am requesting an inspection of my rental dwelling unit by a City of Champaign Property Maintenance Inspector and that I am the tenant under a lease agreement for the property. I understand I will be contacted by the City Inspector to schedule an appointment and understand I must be present for the duration of the inspection.

After submitting this request, you will be contacted by a Property Maintenance Inspector within three business days. If you wish to cancel a scheduled appointment, please contact the Code Compliance Division at 217-403-7070 at least 24-hours prior to the scheduled inspection. You will be asked to complete the “Inspection Cancellation” form.

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