6100-XX6 Draft Provider Quarterly Reporting Form

Draft Quarterly Reporting Form

Reporting Period:

1/1/2010 - 03/31/10

Home 1

Home 2

Home 3

Yes/No

Yes/No

Yes/No

Yes/No
Nonconformity List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Landscape List
Percentage List
Yes/No
Yes/No

Yes/No
Nonconformity List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Landscape List
Percentage List
Yes/No
Yes/No

Yes/No
Nonconformity List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Optional Features List
Landscape List
Percentage List
Yes/No
Yes/No

Section I: General Information
Provider Name:
Provier Contact Information:
Section II: Information on Labeled Homes
Total Number of Homes Labeled this Quarter:
Section III: Information on Homes Inspected
Builder name:
Street address of home:
Zip code of home:
Inspection date:
Was the home part of a sampling regime?
If Y - Provide number of homes labeled through the sampling regime
If Y - Provide name of development
Were nonconformities identified and corrected?
If Y - Identify areas of nonconformity
List the optional features included in the home

Identify portion(s) of the yard that was landscaped by the builder
What percentage of turf was installed?
Did the builder use the water budget tool?
Was an irrigation system installed?