Report Environmental Lead Violations

Online Complaint Form

To report suspected environmental lead violations please complete this form or call 866-865-3233. Information you submit will be forwarded to enforcement inspectors for follow up. Please provide as much information as possible.

Anonymous complaints You may submit an anonymous complaint. However, additional information may need to be obtained and without contact information KDHE inspectors may not be able to follow up on the complaint.

YOUR CONTACT INFORMATION Name: Phone: Email Address

WHO IS THE COMPLAINT AGAINST SUSPECTED VIOLATORS INFORMATION Company/individual name: Address: City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: Phone: The Supsected Violator is a:(check all that apply) Landlord Renovation Firm Paint or home improvement store Unknown Other   If Other please specify.

COMPLAINT INFORMATION VIOLATION DETAILS **Occurance Date and Address where violation occured are required.** Occurance Date(s): Time: AM PM Occurance Date is Required The work involving the violation is: Completed Ongoing Location the violations occured at: Address: Address is Required City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: City is Required State is Required Zip is Required Were pictures taken documenting the violation(s): Yes No Maximum image file size = 4MB Image file types accepted - jpg, jpeg, png, bmp, tiff, gif Maximum number of files accepted = 4 Did you recieve the Renovate Right book prior to renovation work starting at your residence: Yes No Unknown N/A What type of work was being performed? (check all that apply) Window repair/removal Siding removal/replacement Soffit/fascia removal/repair Painting Room addition/demolishment Other (please specify) Did the suspected violator use a lead test kit to determine if lead based paint was present on the property? Yes No Unknown N/A Were signs posted on the property warning occupants and other persons to remain outside of the work area? Yes No Unknown N/A Was the work area isolated? Such as plastic covering doors, windows, HVAC ducts and on the ground; doors and windows within and surrounding the work area were closed. Yes No Unknown N/A Were the personal belongings of the property occupants removed from the work area prior to work beginning? Yes No Unknown N/A Were any of the following practices used? (check all that apply) Open-flame burning or torching Dry scraping Use of power tools without HEPA exhaust control. Such as sanding, grinding, sandblasting, etc. Use of a heat gun Was the waste from the renovation work collected and contained to prevent access to and the release of debris? Such as wrapped in plastic, in a covered dumpster, etc. Yes No Unknown N/A At the conclusion of the renovation activities was the work area cleaned with a HEPA vacuum and/or with a damp cloth/wet mopping system? Yes No Unknown N/A Please list any additional information you would like to submit below.

**If you wish to submit pictures please make sure they are selected**