Form for risk assessment of multi-family residential property

1. Tri-Tech Building Hygiene Services
Building Management Data Checklist for Risk Assessment of
Multi-Family Residential Buildings
Building owner/manager note: The accuracy of this information will assist the Risk Assessor in conducting valid and
representative testing of units. It is advantageous to the building owner to disclose adverse conditions to prevent the
results of the testing of these atypical units being applied to other units. This form is available in an electronic Excel
format upon request.
Part 1: Identifying Information
Number of 0-bedroom units: __________ Number of 1-bedroom units: __________
Number of 2-bedroom units: __________ Number of 3+bedroom units: __________
Total number of 1-3+ bedroom units__________
Building Data (attach an additional sheet if necessary)
Building
address
Building
no./owner
ID
Unit no. range square
footage
year
constructed
type/style of
construction
no. of 1-3+
bedroom
units
Part 2: Management Information
Dates of substantial rehabilitation projects: ____________________________________
Units with code violations in the last five years: _________________________________
Units with chronic maintenance problems in the last five years: ____________________
To your knowledge, are any children with an elevated blood level present? __yes __no
Is previous building lead testing data available? __yes __no
Are there any exterior child play or garden areas? __yes __no
Units vacated and prepared for re-occupancy in the last 3 months: _________________
Units proposed for renovation: ______________________________________________
Units known to contain 2+ children between the ages of 0 and 6: ___________________
Is a HEPA vacuum or other lead control method used (specify)? ____________________
Units with a distinct painting/maintenance history from a typical unit: ______________
Please list knowledgeable maintenance/ management personnel and contact
information: _____________________________________________________________
Please provide a rent roll including unit nos., lessee names and number of children and
floor plans if available.
Thank you for your assistance in helping Tri-Tech Building Hygiene Services make your housing Lead-Safe!