Renovation Recordkeeping Checklist/report
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1Renovation Recordkeeping Checklist/Report
Name of Firm:
Firm No.
Date of renovation:
Location of renovation:
Brief Description of Renovation:
Name of Assigned Renovator:
Name(s) of Trained Worker(s), if used:
Lead Base Paint Testing:
Yes
No
Will the renovation work affect more than the de minimis levels?
Was Lead Base Paint testing performed?
Was EPA-Recognized Test Kits used?
Was a certified LBP inspection or risk assessment performed?
Was Lead Base Paint found?
(see attached documents for results)
Was a copy of the Lead Base Paint testing results given to the owner?
If results of the Lead Base Paint testing were negative or the work being performed is below the de minimis levels, this renovation project is
excluded from the EPA RRP rule.
During and Post Renovation:
Yes
No
N/A
Were all warning signed posted?
Was all of the appropriate containment installed to prevent the spread of dust/debris?
Were all objects in the work area removed or covered (interiors)?
Were the HVAC ducts in the work area closed and covered (interiors)?
Were all windows in the work area closed (interiors)?
Were all windows in and within 20 feet of the work area closed (exteriors)?
Were all doors in the work area closed and sealed (interiors)?
Were all doors in and within 20 feet of the work area closed and sealed (exteriors)?
Were all doors that must be used in the area covered to allow passage but prevent spread of dust?
Were all floors in the work area covered with taped-down plastic (interiors)?
Was ground covered by plastic extending 10 feet from work area—plastic anchored to building and
weighed down by heavy objects (exteriors)?
Was waste contained on-site and while being transported off-site?
Was work site properly cleaned after renovation?
Were all chips/debris picked up, protective sheeting misted, folded inward, and taped for removal?
Was the work area surfaces and objects cleaned using HEPA vacuum and/or wet cloths (interiors)?
Yes
No
Certified renovator performed post-renovation cleaning verification:
(describe results, including the number of wet and dry cloths used)
Yes
No
N/A
Copies of the firm certificate and renovator’s certificate were kept onsite during renovation?
Copies of the Non-Certified Worker Training forms were kept onsite during the renovation?
I certify under penalty of law that the above information is true and complete
Name
Title
Certification Number
Date
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