Lead-Based Paint Visual Assessment and Disclosure Log

Log to document lead-based paint disclosures and visual assessments for pre-1978 housing units in accordance with HUD requirements.

Property and Unit Information

• Property Name
• Unit Number or Identifier
• Property Address
• Year Built
• Is this unit or property built before 1978?

Disclosure Record

• Was the lead-based paint disclosure provided?
• Disclosure Date
• Disclosure Delivery Method
• Was tenant acknowledgment received?
• Acknowledgment Date

Visual Assessment Details

• Assessment Date
• Assessor Name
• Assessment Scope
• Assessment Result

Hazard Observations and Corrective Actions

• Hazard Location
• Observed Condition
  Describe the observed condition without collecting unnecessary personal information.
• Are interim controls or repairs needed?
• Follow-Up Due Date
• Corrective Action Notes

Attestation and Audit Trail

• Submitter Name
• Submitter Role
• Compliance Notes
  Use this field for brief audit trail notes only. Do not include unnecessary PII.
• I attest that this record is accurate to the best of my knowledge and was completed in accordance with applicable HUD lead-based paint documentation requirements.