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Multi-unit building owner data form for Lead Testing


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Form for risk assessment of multi-family residential property

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Multi-unit building owner data form for Lead Testing

  1. 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!