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Lead Paint Precondition

Release Form

Client's Name__________________________________________________Job Number__________

Address________________________________________________________________________________________

Date:____________

It has been observed, by our Auditor (____________________________) during the audit process for weatherization on your residence, that the exterior paint on your home is deteriorated and that there are paint chips on the ground. 

Since your home appears to be built prior to 1978, the date when lead paint was banned for residential structures, you may or may not have lead in the paint.  If there is lead in your house paint your soil may be contaminated and pose a risk for children playing around the perimeter of your home.  We do not test for lead presence in your paint since our funding sources do not allow funds for testing. 

During the process of weatherization we will be following strict "Lead-Safe Work Practices", designed to protect our workers, your family, and your property.  

• Our crews will be establishing a work area with yellow tape and only the workers will be allowed into the work site.
• Our crews will be placing 6 mil poly on the ground to catch any paint chips that may fall during the process of removing your siding. 
• They will wet the paint surfaces, before disturbing, to ensure that no lead dust is generated.
• They will then be using a HEPA Vac to clean up the chips on the poly, rolling the poly up wet, and removing from your property.
• They will, by using the above practices, leave your property with no additional lead contamination.

 

NOTE:  By signing this release form, you are confirming that you have been informed of the present condition of you property and that the possible presence of lead in the soil existed before _______________________________________ performed weatherization on your residence. 

Signature______________________________________________  Date:_________________

Agency Employee Signature________________________________________  Date:__________________