Audit

Owner Information

Name of Owner/Occupant

Address

City, State, Zip

Contact #

Email

Renovation Information

Renovation Address

Unit #

City, State, Zip

Certified Firm Name

Address

City, State, Zip

Contact #

Email

Certified Renovator Name

Date Certified

Test Kit Information

Test Kit #1

Manufacturer

Manufacturer Date

Model:

Serial/Lot #

Expiration Date:

Test Kit #2

Manufacturer

Manufacturer Date

Model:

Serial/Lot #

Expiration Date:

Test Kit #3

Manufacturer

Manufacturer Date

Serial/Lot #

Expiration Date:

Model:

Test Kit Documentation Form Part 2

Renovation Address:

Unit #

City, State, Zip

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media

TEST LOCATION #

Test Kit Used

Description of Test Location:

Result: Is Lead Present

Add media
Certified Renovator Signature
Add signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.