LEAD-BASED PAINT DISCLOSURE CHECKLIST (FOR PRE-1978 PROPERTIES)

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--- PROPERTY INFORMATION ---
[ ] Property Address
[ ] Year Built (approximate)
[ ] Date of Ownership Transfer (Estimated)
[ ] Legal Description (if available)
[ ] Property Type (Single-Family Home, Multi-Family Home, Condominium, Townhouse, Other)
[ ] Seller's Name(s)
[ ] Buyer's Name(s)

--- SELLER'S DISCLOSURES ---
[ ] Known Lead-Based Paint or Hazards?
[ ] Description of Known Lead-Based Paint or Hazards (if any)
[ ] Details of any Lead-Based Paint Inspections or Risk Assessments performed on the property.
[ ] Details of any repairs or remediation work performed to address lead-based paint hazards.
[ ] Date of most recent lead-based paint inspection/risk assessment (if applicable)
[ ] Any other relevant information regarding lead-based paint or hazards on the property.
[ ] Upload of any prior inspection reports (optional)
[ ] Disclosure of any known lead-based paint on removable surfaces (e.g., doors, trim)

--- BUYER'S ACKNOWLEDGEMENTS ---
[ ] I/We have received a copy of the Lead-Based Paint Disclosure Form. (Yes, No)
[ ] Buyer's Acknowledgment of Receipt and Understanding
[ ] Did you/your inspector conduct a risk assessment or inspection? (Yes, No)
[ ] If yes, briefly describe the findings of the risk assessment/inspection (if any).
[ ] Do you intend to take any corrective actions regarding lead-based paint? (Yes, No, Undecided)
[ ] Date of Acknowledgement
[ ] Buyer's Signature

--- INSPECTION/RISK ASSESSMENT (OPTIONAL) ---
[ ] Inspection/Risk Assessment Date (if performed)
[ ] Summary of Inspection/Risk Assessment Findings (if performed)
[ ] Copy of Inspection Report (if available)
[ ] Type of Assessment Performed (if applicable) (Risk Assessment, Inspection, Both, None)
[ ] Description of Areas with Potential Lead-Based Paint Hazards (if identified)
[ ] Estimated Lead Dust Levels (ppm) in Affected Areas (if measured)
[ ] Recommended Remediation Actions (if any) (Encapsulation, Enclosure, Removal, No Remediation Recommended)
[ ] Photos of Areas with Potential Lead Hazards (Optional)

--- SIGNATURES & DATES ---
[ ] Seller Signature
[ ] Seller Signature Date
[ ] Buyer Signature
[ ] Buyer Signature Date
[ ] Agent Signature (Seller's Agent)
[ ] Agent Signature Date (Seller's Agent)
[ ] Agent Signature (Buyer's Agent, if applicable)
[ ] Agent Signature Date (Buyer's Agent, if applicable)

--- APPENDICES/SUPPORTING DOCUMENTS (IF ANY) ---
[ ] Lead-Based Paint Inspection Report
[ ] Lead-Based Paint Risk Assessment Report
[ ] Summary of Previous Repairs/Removals (if any)
[ ] Type of Remediation (if any) (Removal, Encapsulation, Paint-Over, None)
[ ] Date of Remediation (if applicable)
[ ] Name of Contractor (if remediation occurred)
[ ] Estimated Square Footage of Affected Areas (if known)
[ ] Description of Areas with Known Lead-Based Paint

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