THE LEAD-SAFE CERTIFIED GUIDE TO RENOVATE RIGHT
Federal law requires contractors that disturb painted surfaces in homes, child care facilities and schools built before 1978 to be certified and follow specific work practices to prevent lead contamination. Always ask to see your contractor’s certification. Federal law requires that individuals receive certain information before renovating more than six square feet of painted surfaces in a room for interior projects or more than twenty square feet of painted surfaces for exterior projects or window replacement or demolition in housing, child care facilities and schools built before 1978.
• Homeowners and tenants: [renovators must give you this pamphlet before starting work].
• Child care facilities, including preschools and kindergarten classrooms, and the families of children under six years of age that attend those facilities: [renovators must provide a copy of this pamphlet] to child care facilities and general renovation information to families whose children attend those facilities.
By submitting this form you acknowledge you have received a copy of the lead hazard information pamphlet informing you of the potential risk of the lead hazard exposure from renovation activity to be performed in your dwelling unit. And you acknowledge that you received this pamphlet before the work began.
Occupant/Owner First Name: [ ]
Occupant/Owner Last Name: [ ]
Renovator’s Self Certification Option
(for tenant‐occupied dwellings only)
Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below.
[ ] declined – I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant.
[ ] unavailable for signature – I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left).
First Name of Person Certifying Delivery:
Last Name of Person Certifying Delivery:
Attempted Delivery Date:
Where did you leave pamphlet? [Text box]