10/2003
Relocation of Occupants for Projects with Lead Hazard Reduction Activities
Property Address: Owner:
Individual Completing this Form:
Organization:
Date Completed:
Instructions: Review Section A to determine if relocation of occupants is required prior to lead hazard reduction activities. Document relocation activities in Section B.
Section A
Temporary relocation of occupants is required before and during lead hazard reduction activities to a suitable, decent, safe, and similarly accessible dwelling unit that does not have lead-based paint hazards, except under any of the following circumstances (check all that apply):
Work will not disturb lead-based paint, dust-lead hazards or soil-lead hazards.
Only the exterior of the unit is treated; the windows, doors, ventilation intakes, and other openings in or near the worksite were sealed during hazard control work and cleaned afterward; and an entry free of dust-lead hazards, soil-lead hazards, and debris is provided.
Work in the interior of the unit will be completed within one period of eight daytime hours, the worksite is contained so as to prevent the release of leaded dust and debris into other areas, and treatment does not create other safety, health or environmental hazards.
Treatment of the interior of the unit will be completed within five calendar days, the worksite is contained so as to prevent the release of leaded dust and debris into other areas, treatment does not create other safety, health or environmental hazards; the worksite and the area within at least 10 feet of the containment area are cleaned a the end of each work day, and occupants have safe access to sleeping areas, bathroom and kitchen facilities. These facilities can be provided in any convenient location such as another unit.
Owner/Occupant has voluntarily elected to participate in a program to address housing rehabilitation and lead based paint hazard reduction. As a condition for receiving this assistance, the owner/occupant has been advised that they must vacate the property and are not entitled to receive temporary relocation assistance at any level.
Note: HUD has advised that the relocation of elderly occupants is not typically required, so long as complete disclosure of the nature of the work is provided and informed consent of the elderly occupant(s) is obtained before commencement of the work. (see Interpretive Guidance- The HUD Regulation on Controlling Lead-Based Paint Hazards in Housing Receiving Federal Assistance and Federally Owned Housing Being Sold, Question J24, April 16, 2001 version).
If none of these boxes above apply, occupants must be relocated. Before performing the lead hazard reduction activities, review Section B to ensure that the activities in that Section will be done.
Section B
Occupants were temporarily relocated as required and the following activities occurred for occupant protection (check all that apply):
Occupants were not permitted at any time to enter the worksite during hazard reduction activities (unless they are employed in the conduct of these activities at the worksite), until after the hazard reduction work has been completed and clearance, if required, has been achieved.
Dwelling unit and worksite were secured against unlawful entry.
Occupants were properly notified about the relocation.
Occupants were provided temporary housing that was suitable, decent, safe and similarly accessible.
Occupants were provided temporary housing that was demonstrated to be free of lead-based paint hazards.
Occupants were notified that work was completed and they could reoccupy the unit.
REV DATE 211 ITEM 1020030A ‑ TEMPORARY ILLUMINATION UNIT
UCZESTNICY PROGRAMU I EDYCJA (1504 15102003 R) 1
VERSIONS EVOLUTIONS DE CHARTE D’IDENTIFICATION DU PATIENT 14102003 V1
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