Lead Paint Hazard Identification Template
Property Information
Property Address
Year Built
Owner/Contact Name
Contact Phone
Assessment Details
Assessment Date
Assessor Name
Lead Testing Method
XRF
Paint Chip Sampling
Other
Hazard Locations
Room/Area
Surface/Component
Condition (Intact/Deteriorated)
Notes
Recommendations
Recommended Action
Follow-up Date
Assessor Signature
Name
Date