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Lead Safe Atlanta forms for download

To enroll in the Lead Safe Atlanta Program, please use the PDF forms below:


Eligibility (Part 1)
Program guidelines and requirements. All documents listed on the application along with Lead Tenant/Owner Data Form (Part 2), Blood Lead Authorization Form (Part 3) and Visiting Child Verification Form (if applicable) must be turned in prior to approval.   


Occupant Data Form (Part 2)
This form must be filled out by owner in owner-occupied situation and by the tenant in an investor-owned dwelling.  Each unit must complete and sign this form. 


Blood Lead Authorization Form (Part 3)
This form must be filled out by the parent or legal guardian of the occupying or visiting child. The child's name, DOB (date of birth) and signature on the bottom are required. By signing this form, the parent/legal guardian authorizes the Lead Program to receive a copy of the child's lead test records. Child between one and six (1-6) must be tested within six months of housing intervention.


Visiting Child Verification Form
This form must be filled out by the owner/tenant to certify that a child six or under spends at least two days per week, three hours per visit, 60 hours per year at residence, if there is not a child six or under living in the property.


Vacant Agreement
This form must be filled out if the property or a unit is vacant.   


When ALL requirements are met and ALL forms are completed and signed, please mail ALL required paperwork to the following address, or call the Lead Safe office with any questions:



Lead Safe Atlanta
477 Windsor Street, Suite 101
Atlanta, GA 30312

Contact: 404-223-3303 | Web: www.LeadSafeAtlanta.com | Info: 404-546-LEAD




faq
Please click above for FAQ

 



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Copyright © 2011 Green & Healthy Homes Initiative Atlanta. All Rights Reserved.
Lead Safe Atlanta and Healthy Homes Atlanta are two great programs under the Green and Healthy Homes Initiative designed to provide free, practical improvements in your home to increase health and safety for your family.

For information on GHHI Atlanta and the Healthy Homes Atlanta program:
Phone: 404-223-3303 or email: ghhi@tcwfi.org
Fax: 404-586-0513

For information on the Lead Safe Atlanta program:
Phone: 404-546-LEAD or email: ghhi@tcwfi.org
Fax: 404-586-0513

By Mail:
The Center for Working Families, Inc.
Attn: Green and Healthy Homes
477 Windsor Street | Suite 101
Atlanta, GA 30291

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