Lead Paint

Street Address:
 

Apartment number:
 

City:
 

Zip code:
 

Number of people in household:
 

Any children 6 yrs or under?
Yes
No

Date completed tool:
 

Did you have a home visit by program Staff?
Yes
No

Email address:
 

Do you want to be notified of updates and new services by the program?
Yes
No

Your Score: How many boxes were checked off on your home tool? 0-25 should be optimal.
 


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