Form Sample renovation Sample renovation Sample renovation recordkeeping checklist

TSCA Section 402 and Section 404 Training and Certification, Accreditation and Standards for Lead-Based Paint Activities (Opt-out and Recordkeeping Amendments Final Rule)

word recordkeeping checklist

Local governments (LBP RRP activities); non-certification year recordkeeping actvities

OMB: 2070-0155

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Sample Renovation Recordkeeping Checklist


Name of Firm:________________________________________________________________

Date and Location of Renovation:_________________________________________________

Brief Description of Renovation: _________________________________________________

____________________________________________________________________________

Name of Assigned Renovator:____________________________________________________

Name(s) of Trained Workers, if used:______________________________________________

____________________________________________________________________________

Name of Dust Sampling Technician, Inspector, or Risk Assessor, if used:__________________

_____________________________________________________________________________

Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file.

 Certified renovator provided training to workers on (check all that apply):

 Posting warning signs  Setting up plastic containment barriers

 Maintaining containment  Avoiding spread of dust to adjacent areas

 Waste handling  Post-renovation cleaning

Test kits used by certified renovator to determine whether lead was present on components affected by renovation (identify kits used and describe sampling locations and results):_____________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

 Warning signs posted at entrance to work area.

 Work area contained to prevent spread of dust and debris

 All objects in the work area removed or covered (interiors)

 HVAC ducts in the work area closed and covered (interiors)

 Windows in the work area closed (interiors)

 Windows in and within 20 feet of the work area closed (exteriors)

 Doors in the work area closed and sealed (interiors)

 Doors in and within 20 feet of the work area closed and sealed (exteriors)

 Doors that must be used in the work area covered to allow passage but prevent spread of dust

 Floors in the work area covered with taped-down plastic (interiors)

 Ground covered by plastic extending 10 feet from work area—plastic anchored to building and weighted down by heavy objects (exteriors)

 If necessary, vertical containment installed to prevent migration of dust and debris to adjacent property (exteriors)

 Waste contained on-site and while being transported off-site

 Work site properly cleaned after renovation

All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for removal

Work area surfaces and objects cleaned using HEPA vacuum and/or wet cloths or mops (interiors)

Certified renovator performed post-renovation cleaning verification (describe results, including the number of wet and dry cloths used):________________________________

_______________________________________________________________________________________________________________________________________________

 If dust clearance testing was performed instead, attach a copy of report.

 I certify under penalty of law that the above information is true and complete.


_________________________________________________ ________________________

name and title date

File Typeapplication/msword
File TitleName of Firm:________________________________________________________________
AuthorCindy Wheeler
Last Modified ByOPPT
File Modified2008-03-31
File Created2008-03-31

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