Jump to main content.

Pre-Renovation Education Rule
Tip/Complaint Form

* Denotes a required field.

Directions: Complete as much as possible.

1.

(a.) Contractor's name, address, and telephone number:

* Name:
* Street:
* City * State: * ZIP:
* Phone:
Alternate Phone:

(b.) Property owner's and/or manager's name, address and telephone number:

Name:
Street:
City State: ZIP:
Phone:
Alternate Phone:

(c.) Number of occupants in building:

(d.) Your Name & Address

You are a:
Name:
Street:
City: State: ZIP:
Phone:
Alternate Phone:
E-mail:

2. General Information

* (a) Age of Property or Year Built:
   
* (b) Number of Children Residing in the Apartment/House:
   
* (c) Number of Children Residing in the Entire Building:
   
* (d) Are there children with elevated blood lead levels at this address?
   
* (e) Type of Housing:

3. Renovation

(a) Type of renovation work that was completed:
(b) Start date of renovation work:
(c) Did the renovator disturb more than 2 square feet of paint?

4. Notification

(a) Did you receive an EPA-approved lead hazard information pamplet?
   
(b) Did you receive a notice from the renovator about the renovation work, including the start date and end date of the work?
   
(c) Is the renovation work still ongoing?

5. Comments

 

Serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, & Tribal Nations

Local Navigation

Jump to main content.