Section 410.821 - Inspection FormEach board of health shall adopt and use a printed inspection report form which must include, but need not be limited to, the following:
(A) specifically labelled spaces for: (1) name of the inspector;(2) the date and time of the inspection or investigation;(3) the location of the dwelling or dwelling unit inspected;(4) the date and time of any scheduled follow-up inspection;(5) a description of the conditions constituting violations;(6) a listing of the specific provisions of 105 CMR 410.000 or other applicable laws, ordinances, by-laws, rules or regulations that appear to be violated;(7) a determination by the official inspecting the premises whether the violations are listed in 105 CMR 410.750, and whether the effect of any violation(s) or conditions not listed in 105 CMR 410.750 may endanger or materially impair the health or safety, and well-being of any person(s) occupying the premises.(8) the signature of the inspector preceded by the following statement: This inspection report is signed and certified under the pains and penalties of perjury.(B) A brief summary of the legal remedies available to the occupant of the affected premises, followed by this statement: "The information presented above is only a summary of the law. Before you decide to withhold your rent or take any other legal action, it is advisable that you consult an attorney. If you cannot afford to consult an attorney, you should contact the nearest Legal Services Office which is (name of Legal Services Office), (address), (telephone number)."