Lead-Safe Wisconsin - Alphabetical List of Forms and Publications

The forms and publications in this section are available from the Wisconsin Department of Health Services (DHS), US Environmental Protection Agency (EPA), or US Department of Housing and Urban Development (HUD). DHS forms may either be downloaded and printed through the provided links or the EPA publications may either be downloaded and printed through the provided link or ordered through the National Lead Information Center.

Application for Registration of Lead-Free or Lead-Safe Property (F-44011, PDF, 48 KB)
Lead investigators performing a lead-free inspection or lead-safe investigation can use this form to apply for registration of a property.

Blood Lead Lab Reporting (F-00017, Word Fillable, 101 KB)  
Health care providers and laboratories can use this form to report blood lead test results of Wisconsin residents. This form includes the reporting timetable based on the blood lead test result. Providers and laboratories must report results to DHS according to this timetable.

Certification Application - Company (F-00171, PDF, 16 KB)
Complete this form to apply for certification of a lead company. This can also be completed for renewal of certification.

Certification Application - Individual (F-44003, PDF, 36 KB)
Complete this form to apply for to become certified to do lead hazard investigations or reduction work.  This can also be completed for renewal of certification.

Contractors/Painters/Home Remodelers: Look Out for Lead (P-44529, PDF, 294 KB)
A tri-fold pamphlet for contractors providing basic information to consider before starting a remodeling job, such as using lead-safe work practices and notifying families with young children about how to protect their family from lead hazards in the home.

Coping With Your Child's Diagnosis (PDF, 590 KB)
A booklet for parents/caregivers acknowledging the emotions experienced when told a child has been lead poisoned.

Help Yourself to a Healthy Home (PDF, 1.3 MB) | En Español (PDF, 1 MB)
A self-help booklet for parents/caregivers that covers housing-related health issues such as asthma, lead, etc.

Lead Abatement Worker, General Supervision Qualification Affidavit (F-44015, PDF, 12 KB)
A lead company must complete this form before a lead abatement worker performs enclosure or encapsulation abatement activities under general supervision.

Lead In Your Home: A Parent's Reference Guide (PDF, 362 KB)
A 70-page illustration book with information on lead poisoning prevention for parents of young children living in a pre-1978 home with lead-based paint.

Lead Paint Safety: A Field Guide for Painting, Home Maintenance, and Renovation Work (PDF, 1.4 MB) | En Español (PDF, 1.9 MB)
A step-by-step manual that illustrates the safety precautions to take when painting, doing maintenance, or renovating in homes built before 1978.

Lead-Based Paint Investigation Summary Report (F-44013, PDF, 15 KB) 
Lead investigation companies must complete this form or file lead investigation reports on the internet through WALDO. NOTE: This form is fillable and can be printed, but cannot be saved.

Lead-Free Inspection Affidavit of Property Owner (F-44014, PDF, 11 KB)
Lead Investigators performing a lead-free inspection must have this completed form or a clearance report on file.

Lead-Free / Lead-Safe Property Registry, Training Course, Class and Roster Database Access Application (F-44010, PDF,12 KB)  
Lead Investigators, contractors, and training providers requesting access to the Wisconsin Asbestos Lead Database Online must complete this application.

Look Out for Lead: Where to Look coloring sheet (P-00819, PDF, 869 KB)| En Español (P-00819, PDF, 869 KB)
An activity sheet which identifies places in the home and yard where lead hazards can be found.

Notification of Lead-Based Paint Activity (F-44012, PDF, 26 KB)
Lead supervisors must complete and submit this form before lead work takes place.

Nursing Case Management Report (P-44771A, PDF, 34 KB)
Nursing Case Management Report (P-44771A, Word Fillable)
This form is used by local health department staff for case management of children with elevated blood lead levels.

Nursing Case Closure Report (P-44771B, PDF, 26 KB)
Nursing Case Closure Report (P-44771B, Word Fillable)
This form is used by local health department staff for case management of children with elevated blood-lead levels.

Occupant Protection Plan (F-44016, PDF, 26 KB)
The lead company must complete and submit this form before lead work takes place, in accordance with form instructions.

Parents: Look Out for Lead (P-44535A, PDF, 92 KB) | En Español (P-44535A, PDF, 92 KB)
A tri-fold pamphlet for parents and caregivers providing basic information about blood lead testing, where to look for lead hazards and what to do about them.

Property Investigation Report (F-44771C, PDF, 46 KB)
Property Investigation Report (F-44771C, Word Fillable)
This form is used by local health department staff for property investigation of properties with children with elevated blood lead levels.

Property Investigation Closure Report (F-44771D, PDF, 24 KB)
Property Investigation Closure Report (F-44771D, Word Fillable)
This form is used by local health department staff for property investigation of properties with children with elevated blood lead levels.

Protect Your Family From Lead in Your Home
Owners of pre-1978 housing are required to give this pamphlet to tenants when entering into or renewing a rental agreement (PDF, 6 MB) in other languages).

Renovate Right (PDF, 3.3 MB) | En Español (PDF, 3.2 MB)
This handbook for contractors, property managers, and maintenance personnel describes the requirements that apply when more than 6 square interior feet or 20 square exterior feet of surface with lead-based paint is disturbed. It also includes general information about legal requirements for lead-safe work practices for homeowners, tenants, child care providers and parents during renovation activities.

Rental Property Owners: Look Out for Lead (P-44535B, PDF, 334 KB)
A tri-fold pamphlet for rental property owners who own properties built before 1978 that may contain lead hazard and may be occupied by families with young children. Includes information on what can be done to correct lead hazards and about the law to notify tenants about lead hazards and how to prevent exposure to lead.

Request for Repairs (F-44018, PDF, 20 KB)
This form is to be given to tenants by the property owner of registered lead-safe property before repairs commence.

Visual Inspection of Registered Lead-Safe Property (F-44005, PDF, 11 KB)
Property owners of a registered lead-safe property are to complete this form annually, to maintain certification.

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Last Revised: May 7, 2015