Property Lead Dwelling Assessment

PROPERTY LEAD DWELLING ASSESSMENT

Property Address:

Parcel / APN:    Assessment Date:

Inspector and Client Identification

Assessment Scope and Methods

Assessment Type (check all that apply):

Visual inspection    XRF screening    Paint-chip sampling    Dust-wipe sampling    Soil sampling    Other:

Occupancy and Vulnerable Populations

Children under age six present on site: Yes    Pregnant persons present on site: Yes    Other vulnerable occupants present: Yes

Visual Inspection Findings

Deteriorated paint observed: Yes    No

Bare soil in play areas: Yes    No

Friction or impact surfaces (windows, doors, stairs) with deterioration: Yes    No

Sampling Results (record each sample)

Sample 1

Location: Method: Result:

Sample 2

Location: Method: Result:

Sample 3

Location: Method: Result:

Hazard Determination and Recommendations

Lead-based paint or lead hazard determined to be present: Yes    No    Undetermined

Immediate measures required to protect occupants (check all that apply):

Restrict access to affected areas    Contain and isolate work area    Specialized cleaning (HEPA)    Temporary relocation of occupants

Clearance and Post-Work Testing

Clearance testing performed following controls/abatement: Yes    No

Clearance result: Passed    Failed

Clearance date:

Notifications and Acknowledgements

Occupants provided with assessment findings and guidance: Yes    No

Notification date:    Notification method:

Limitations, Certification and Governing Law

LIMITATIONS: This assessment reports conditions observed and samples taken on the date of assessment only. It is not a guarantee or warranty of the absence of lead hazards at other times or in other parts of the property. Sampling is limited to the surfaces and locations indicated above and to the analytical or screening methods selected. Suspected lead hazards not accessible at the time of evaluation may remain undetected.

CERTIFICATION: The inspector certifies, under penalty of perjury, that the information reported herein is true and correct to the best of the inspector's knowledge and based on accepted professional procedures and applicable standards at the time of the assessment. The property owner acknowledges responsibility to abate or control identified hazards, to follow recommended interim controls, and to comply with applicable statutes and regulations governing lead hazard reduction.

LIMITATION OF LIABILITY: The inspector's liability for claims arising from the assessment is limited to documented negligence in the performance of the assessment and shall not include consequential damages, unless otherwise required by law. This document does not transfer responsibility for continuing maintenance or future exposures from the property owner to the inspector.

GOVERNING LAW: This assessment, its interpretation and any dispute between the parties shall be governed by the laws of the jurisdiction in which the property is located.

ENTIRE AGREEMENT: This document, together with any attachments and laboratory reports referenced herein, constitutes the entire written assessment agreement between the inspector and the property owner with respect to the subject assessment.

Attachments and References

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