Federal Renovation, Repair, and Painting (RRP) Rule
Tip & Complaint Form

• Street:*
• City:*
• State:* Please Select Arizona California Hawaii Nevada
• Zip:
• Name of Property Owner or Management Company:
• Name of the Residential Complex or Child-Occupied Facility:
• Was the residence/facility built before 1978?*
• yes
• no
• When did the work begin? (estimate)* (mm/dd/yyyy)
• Estimate number of days until the work will end.*
• Are there any young children living in or around the work site?
• yes
• no
• unknown
• Are there any pregnant women living in or around the site?
• yes
• no
• unknown

• Company Name:*
• Name of Company Contact Person:
• Company Street Address:
• City:
• State: Please Select Arizona California Hawaii Nevada
• Zip:
• Company Phone Number: (###-###-####)
• Company eMail address:
• Vehicle License Plate Number:
• Contractor License Number:
• EPA RRP Certificate Number:

• Please provide a brief description about the work site.
  (e.g., room remodeling, exterior painting, window replacement).
  (500 characters max)
  
  characters left

• How do you know that this is a work site?
  (Mark all that apply.
  Hold down Ctrl key (PC) or Command key (Mac) for multiple selections):

  reserved contractor parking scaffolding containment bins/trough fans dust noise contractors/ workers dumpster caution tape paint chips

• The Renovation, Repair and Painting Rule applies to major renovations defined by size or type of project.
  Please use the following questions to let us know what qualifies this work as a major renovation.

• Did the contractor disturb more than 6 square feet of interior (e.g., 3x2 ft) painted surface?
• yes
• no
• Did the contractor disturb more than 20 square feet of exterior (e.g., 5x4 ft) painted surface?
• yes
• no
• Did the contractor replace any windows?
• yes
• no
• If yes to any of the questions above, check all circumstances from below that give evidence of disturbed paint or the creation of any other lead-based paint hazards or violations.
  
  
• Power tools:
  Did power tools create dust or paint chips?
  (check any that apply)
  
• scraping (e.g. sander, planar) washing (e.g. pressure washer) burning (e.g. open fire torch)
•  other:(50 characters max)
• Containment:
  Are the dust or paint chips being captured and contained?
  (check any that apply)
• Is the machinery collecting dust or paint chips in proper bins/filters/containers?
• yes
• no
• Are the dust or paint chips escaping the work area?
• yes
• no
  other:(50 characters max)
  
• Contractors:
  Are contractors certified and using protective equipment and clothing? (check any that apply)
• Are contractors using appropriate equipment and clothing to prevent inhalation of dust or paint chips?
• yes
• no
• Is the contractor certified by EPA to work on lead-based paint?
• yes
• no
  other:(50 characters max)

• Is there anything else you would like to add? (e.g., Include any information regarding the release of dust and/or paint chips into the surrounding area or any other off-site contamination.)

  (1000 characters max)
  
  characters left

Your contact information is optional and is not confidential.

• Name:
• Street address:
• City:
• State: Select State Arizona California Hawaii Nevada
• Zip Code:
• Phone Number: (###-###-####)
• eMail address:
• May we contact you for clarification or further information?
• yes no