Healthy Homes Compliance Statement

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Property & compliance status

Front page of the official statement

Property address auto-filled

Compliance status

The landlord(s) named below declare that the premises will comply with the healthy homes standards by the healthy homes compliance date

The landlord(s) named below declare that the premises comply with the healthy homes standards

The premises do not comply with the healthy homes standards because a general exemption applies (see next section)

The premises comply with the healthy homes standards but with specific standard exemption(s)

Which standards have exemptions?

Heating

Insulation

Ventilation

Moisture ingress and drainage

Landlord name(s) auto-filled

Healthy homes compliance date

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General exemptions

12-month exemptions that apply to the whole property

General exemptions last 12 months and apply to all healthy homes standards. Tick any that apply, or leave both unchecked if no general exemption applies.

The tenant is the immediate former owner of the premises (12-month exemption)

Describe the circumstances

The landlord intends to demolish or substantially rebuild the premises and has applied for building consent (12-month exemption)

Describe the demolition/rebuild plans and consent status

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Heating standard

Fixed heater in the main living room, correct type and capacity

Q1. Does an exemption apply to the heating standard?

No heating exemption applies

Yes, exempt from qualifying heaters

Partial exemption: landlord does not own the whole building

Describe the reason for exemption

Describe the partial exemption

Q2. Required heating capacity for the main living room (kW)

Calculate the required heating capacity using the Heating Assessment Tool at tenancy.govt.nz/heating-tool

Q3. The property qualifies as a modern dwelling or relevant apartment (built on or after 1 July 2008)

Describe why the property qualifies

Q4. Type of heater(s) in the main living room

Heating capacity of heater 1 (kW)

Heating capacity of heater 2 (kW) optional

Heating capacity of heater 3 (kW) optional

Q5. Is a tolerance or top-up heater being used to reach the required capacity?

No

Yes

Describe the tolerance or top-up arrangement

Q6. The main living room heating has been assessed by a suitably qualified specialist under regulation 10A

Describe the assessment

Name and qualifications of the specialist

Q7. The main living room is heated by geothermal heating under regulation 10B

Describe the geothermal heating system

Details not provided because the information does not yet exist or compliance with the heating standard is not yet required

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Insulation standard

Ceiling, underfloor, and wall insulation details

Ceiling insulation

Q1. Does the premises have ceiling insulation?

R-value when installed

Type of insulation

I don't know the R-value

Thickness of insulation (mm)

Date installed

Date last inspected

Insulation is in reasonable condition

The R-value may be stapled to a beam or recorded in the council building file.

R-value when installed

Type of insulation

I don't know the R-value

Date installed

Date last inspected

Insulation is in reasonable condition

Which areas have ceiling insulation?

Which areas are exempt from insulation and why?

Does an R-value exemption for insulation installed before 1 July 2016 apply?

Yes

No

Describe the exemption

Why is there no ceiling insulation?

Underfloor insulation

Q2. Does a partial exemption apply for certain thermal underfloor insulation?

No

Yes

Describe the partial exemption

Q3. Does the premises have underfloor insulation?

R-value

Type of insulation

Date installed

Date last inspected

Insulation is in reasonable condition

R-value

Type of insulation

Date installed

Date last inspected

Insulation is in reasonable condition

Which areas have underfloor insulation?

Which areas are exempt and why?

Why is there no underfloor insulation?

If exempt but unsure, explain

Wall insulation

Q4. Does the premises have wall insulation?

Details of wall insulation

Which areas have wall insulation?

Details

Explain why you don't know

Details for ceiling and/or underfloor insulation are not provided because the information does not yet exist or compliance is not yet required

Details for wall insulation are not provided because the information does not yet exist or compliance is not yet required

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Ventilation standard

Openable windows, extractor fans, and mechanical ventilation

Q1. Do all habitable spaces have openable windows?

Which rooms meet the openable window requirement?

Which rooms do not meet the requirement?

Exemption details for each non-compliant room

Note: Recirculating systems (e.g. HRV, DVS) are not suitable to meet the ventilation standard for kitchens and bathrooms.

Kitchen and bathroom ventilation (complete Q2 OR Q3)

Q2. Are extractor fans installed?

Kitchen extractor fan diameter/capacity and which room

Bathroom extractor fan diameter/capacity and which room

Which rooms have extractor fans? (diameter/capacity per fan)

Which rooms do not have extractor fans?

Why are those rooms exempt?

Why are extractor fans not installed? (exemption details)

Q3. Continuous mechanical ventilation (alternative to extractor fans)

(A) Original building consent ventilation system (on or after 1 November 2019)

Describe the system

(B) Retrofitted system providing at least 12 l/s for kitchen and 10 l/s for bathroom

Describe the retrofitted system

Details not provided because the information does not yet exist or compliance with the ventilation standard is not yet required

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Moisture ingress & drainage

Drainage, subfloor, and ground moisture barriers

Q1. Does the property have an efficient drainage system for the removal of stormwater, surface water, and ground water?

Yes - the property has efficient drainage

Q2. Does the property have an enclosed subfloor?

Yes

No

Q3. Is a ground moisture barrier installed?

Yes

No

Why is a ground moisture barrier not installed?

Details not provided because the information does not yet exist or compliance with the moisture standard is not yet required

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Draught stopping

Gaps, holes, and open fireplaces

Q1. Are there any open fireplaces?

Yes

No

How are open fireplaces managed?

Q2. Is the property free from unreasonable gaps and draughts?

Yes - property is free from unreasonable gaps and draughts

No

Describe the draught issues and what will be done

Details not provided because the information does not yet exist or compliance with the draught stopping standard is not yet required

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Landlord declaration

Sign and date this compliance statement

Landlord name(s) auto-filled

I declare that the information provided in this compliance statement is true and correct

Print, sign, and date this compliance statement. Provide a copy to the tenant at or before the start of the tenancy.

Date signed auto-filled

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Healthy Homes Compliance Statement

Property & compliance status

General exemptions

Heating standard

Insulation standard

Ceiling insulation

Underfloor insulation

Wall insulation

Ventilation standard

Kitchen and bathroom ventilation (complete Q2 OR Q3)

Q3. Continuous mechanical ventilation (alternative to extractor fans)

Moisture ingress & drainage

Draught stopping

Landlord declaration

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