Inspection Report

Observations

• Apartment doors are closed without damage.
• The electrical panel at apt. 168 is open.
• On the stair landing between the 3rd and 4th floors, glass shards are scattered in disorder. The window to the street is broken.
• On the 4th floor stair landing, on the left side, the metal door to the hall is open.
  • Apartments No. 169 and 170 are located in the hall.
  • The door to apartment No. 169 is open. The door in it has no damage. On the floor of the stair landing are glass shards.
  • On the right side are apartments No. 171 and No. 172. The doors of apartments No. 171 and 172 are open. The electrical panel room at apartment 172 is open.
  • On the stair landing between the 4th and 5th floors are glass shards; a television is damaged. The window is broken.
• On the 5th floor stair landing, on the left side are apartments 173 and 174. The doors to the apartments are open. The electrical panel room at apartment 173 is open.
  • The elevator door is slightly open (distance between doors 2 cm).
  • On the right side are located apt 175 and 176. The doors to the apartments are open. Glass is on the floor.
• On the stair landing between the 5th and 6th floors, glass shards and a window frame are on the floor. The window is broken.
• On the 6th floor stair landing, apartments No. 177 and 178 are located.
  • The door of apartment 177 is closed.
  • The door of apartment 178 is off its hinges.

Conclusion

Inspection ended at [ ] hours [ ] min. The protocol was read to all persons participating in the inspection, comments [blank] (if comments were received — indicate from whom and what).

Signatures

• Witnesses 1. [signature]
• Specialists 1. [signature]
• [signature]
• [signature] (signatures of other persons participating in the inspection)
• Investigator [signature]

[Stamp: For inquiries]
[Handwritten: True copy]
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