Date:
School Contact Person for Survey:
Phone:
Email:
Section I. Risk of lead in paint, soil and dust.
Do you have any school buildings constructed prior to 1978?
If yes, how many buildings:
Do children 6 years of age and younger occupy or visit your school more than two days a week?
(A child-occupied facility is defined as a building or portion of a building constructed prior to 1978
and visited regularly by the same child, 6 years of age or under, on at least two different days within
any week. Child-occupied facilities may include, but are not limited to, day care centers,
preschools/kindergartens and common areas of schools.)
Has your school ever been tested for lead-based paint (LBP), lead in soil or lead in dust by a North
Dakota-certified LBP Inspector/Risk Assessor?
(North Dakota Lead-based Paint Firms)
Does your school have deteriorated paint or varnish on the inside or outside of your building(s) or on
playground equipment?
(Deteriorated paint or varnish is paint or varnish that is cracking, flaking, chipping, peeling or
otherwise separating from the substrate of the building component.)
Do you plan to conduct any renovation work at your school in the next two years that will impact a painted,
varnished or stained surface?
(Testing prior to renovation is required for LBP. LBP Inspectors and Risk Assessors are required to have
a North Dakota LBP certificate. The U.S. Environmental Protection Agency’s [EPA] Lead Renovation, Repair
and Painting Rule [RRP] requires that general contracting firms performing renovation, repair and
painting projects in pre-1978 schools, day care centers and child-occupied facilities be certified by
EPA, use certified and trained workers and follow lead safe work practices.)
Have any of your maintenance personnel attended certified LBP abatement or LBP renovation, repair and paint
(RRP) training in the past six years?
Has your school been part of an elevated blood lead level environmental investigation?
(The North Dakota Department of Health and/or the local public health unit would have been present in the
school to conduct the environmental investigation.)
Section III. Any yes response in Sections I and II indicates your school could have potential for the
presence of lead hazards. The risk level increases with the number of yes answers.
Are you interested in obtaining additional information to help further assess your school for lead hazards?
For more information:
www.deq.nd.gov/LeadInSchools/default.aspx
Lead-Based Paint Program (701-328-5188)
Drinking Water Program (701-328-5211)
Email:
LeadInSchools@nd.gov