Tri-Tech Building Hygiene Services

Building Management Data Checklist for Risk Assessment of

Multi-Family Residential Buildings

Building owner/manager note: The accuracy of this information will assist the Risk Assessor in conducting valid and

representative testing of units. It is advantageous to the building owner to disclose adverse conditions to prevent the

results of the testing of these atypical units being applied to other units. This form is available in an electronic Excel

format upon request.

Part 1: Identifying Information

Number of 0-bedroom units: __________ Number of 1-bedroom units: __________

Number of 2-bedroom units: __________ Number of 3+bedroom units: __________

Total number of 1-3+ bedroom units__________

Building Data (attach an additional sheet if necessary)

Building

address

Building

no./owner

ID

Unit no. range square

footage

year

constructed

type/style of

construction

no. of 1-3+

bedroom

units

Part 2: Management Information

Dates of substantial rehabilitation projects: ____________________________________

Units with code violations in the last five years: _________________________________

Units with chronic maintenance problems in the last five years: ____________________

To your knowledge, are any children with an elevated blood level present? __yes __no

Is previous building lead testing data available? __yes __no

Are there any exterior child play or garden areas? __yes __no

Units vacated and prepared for re-occupancy in the last 3 months: _________________

Units proposed for renovation: ______________________________________________

Units known to contain 2+ children between the ages of 0 and 6: ___________________

Is a HEPA vacuum or other lead control method used (specify)? ____________________

Units with a distinct painting/maintenance history from a typical unit: ______________

Please list knowledgeable maintenance/ management personnel and contact

information: _____________________________________________________________

Please provide a rent roll including unit nos., lessee names and number of children and

floor plans if available.

Thank you for your assistance in helping Tri-Tech Building Hygiene Services make your housing Lead-Safe!