Asbestos and Lead-Based Paint Survey Checklist

Project Name:
Project Address:
Survey Date:
Survey Performed By:
Asbestos Survey
Item Yes No Comments
Previous asbestos survey available?
Suspect materials identified?
Samples collected?
Laboratory analysis completed?
Results indicate asbestos present?
Asbestos abatement required?
Lead-Based Paint Survey
Item Yes No Comments
Previous lead-based paint survey available?
Painted surfaces inspected?
Samples collected?
Laboratory analysis completed?
Lead-based paint present?
Lead abatement required?
Additional Notes
Surveyor Signature:
Date Signed: