Documentation for Testing for Lead-Based Paint
Renovation Address:
Name of Owner/Occupant: ______
Address: ______
City: ______State: ______Zip code: ______Contact #: (____) ____- _____
Email: ______
Contractors Information:
Certified Firm Name: ______
Address: ______
City: ______State: ______Zip code: ______Contact #: (____) ____- _____
Test Kit Information
Test Kit Used: ______
Testing Information
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Test Location # ____
Description of test location: ______
______
Result: Does the paint test positive for lead? ______Yes _____ No
Form provided by The InService Training Network, Inc. for use by a Certified ContractorPage ___ of ___