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HUD   >   Program Offices   >   Healthy Homes and Lead Hazard Control   >   2012_HUDGuidelines_Forms

2012 HUD Guidelines Forms 

Chapter 5: Risk Assessment

 

   

Form 5.0 Questionnaire for a Lead Hazard Risk Assessment of an Individual Occupied Dwelling Unit

Word

PDF

Form 5.1 Building Condition Form for Lead Hazard Risk Assessment

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PDF

Form 5.2 Report of Visual Assessment (for Lead Hazard Risk Assessment)

Word

PDF

Form 5.3 Field Paint Chip Sampling Form

Word

PDF

Form 5.4a Field Sampling Form for Dust. (Single-Surface Sampling)

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PDF

Form 5.4b Field Sampling Form for Dust. (Composite Sampling) 

Word

PDF

Form 5.5 Field Sampling Form for Soil

Word

PDF

Form 5.6 Questionnaire for a Lead Hazard Risk Assessment of More Than Four Rental Dwelling Units

 

Word

PDF

Form 5.7 Format for an Executive Summary of a Lead Hazard Risk Assessment.

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PDF

Chapter 6: Ongoing LBP Maintenance

   

Form 6.0 Report of Visual Assessment (for Ongoing Lead-Safe Maintenance).

Word

PDF

Form 6.1 Report of Visual Assessment of Bare Soil for Lead-Safe Maintenance

Word

PDF

Form 6.2 Log of Visual Assessments for Ongoing Lead-Safe Maintenance

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PDF

Form 6.3 Lead-Based Paint Inventory

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PDF

Form 6.4 Lead Hazard Control Inventory

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PDF

Form 6.5 Lead-Safe Maintenance Work Order

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PDF

Chapter 7: LBP Inspection

 

   

Form 7.1 and 7.5 Single-Family and Multifamily Testing LBP Testing Data Sheet

Word

PDF

Form 7.2 Calibration Check Test Results

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PDF

Form 7.3 Substrate Correction Values

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PDF

Form 7.4 Selection of Housing Units

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Form 7.6 Multifamily Housing: Component Type Report

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PDF

Chapter 13: Abatement by Encapsulation

 

   

Form 13.1 Encapsulant Patch Test Documentation

 

Word

PDF

Form 13.2 Lead-Based Paint Encapsulation Visual Monitoring Form

Word

PDF

Chapter 15: Clearance

 

   

Form 15.1 Visual Assessment - Lead Hazard Clearance Examination.

Word

PDF

Form 15.2 Field Sampling Form for Dust-Lead Hazard Clearance Examination (single-surface sampling)

Word

PDF

Form 15.4 Clearance Report Review Worksheet

Word

PDF

Chapter 16: Investigation and Treatment of Housing with EBL Children

 

   

Form 16.1 Resident Questionnaire for Investigation of Children with Elevated Blood Lead Levels (EBL)

Word

PDF