The Ohio HEA 5802 form is a monthly summary report required by the Ohio Department of Health for documenting lead inspection, risk assessment, and clearance examination activities. This form must be completed and submitted by the 15th of each month to ensure compliance with state regulations. It is essential to provide accurate information for each property and activity to avoid delays or rejections of the submission.
The Ohio HEA 5802 form plays a crucial role in the state's efforts to monitor and manage lead hazards in residential properties. This monthly summary form is designed for licensed lead inspectors, risk assessors, and clearance technicians to report their activities related to lead inspections, risk assessments, and clearance examinations. Each submission must detail activities from the previous month and is due by the 15th of each month. If no activities occurred, the form allows for a simple indication of "no activity." It is essential to complete all sections of the form accurately, as incomplete submissions will be returned. The form requires separate entries for each property and activity, ensuring clarity in reporting. For instance, if a clearance examination fails initially but passes upon reexamination, both outcomes must be documented separately. Additionally, the form includes specific questions about whether a lead hazard was found and whether the property was constructed before 1950, as these factors are critical in assessing lead exposure risks. Submissions can be made via mail, fax, or email, providing flexibility for users. Understanding the HEA 5802 form is vital for maintaining compliance with Ohio's lead poisoning prevention regulations and ensuring the safety of residents.
Ohio Department of Health • Lead Poisoning Prevention Program
Lead Monthly Summary
Page 1 of
Lead Inspection/Risk Assessment/Clearance Examination Activity
1.In accordance with paragraph (D) of rule 3701-32-15 of the Ohio Administrative Code this monthly summary form shall be completed to report each previous month’s activities. This form should be submitted by the 15th of each month. If there was no activity performed that month, check the “no activity” box.
2.Please complete all parts of this form. This form will be returned if any information is lacking.
3.Please complete a separate line for each property address and each activity. For example, if you conducted a clearance examination at 111 Main Street and the examination initially failed, but passed upon reexamination, you should enter each examination as a separate line. One line should be completed for the failed examination and one line for the passed examination.
4.You should always indicate “Yes” to the question “Was a lead hazard found” if the property failed clearance examination.
5.You should always indicate “No” to the question “Was a lead hazard found” if the property passed the clearance examination.
6.Monthly summary forms can be submitted by one of the following methods:
•Sent by first class mail to: Ohio Department of Health,
DQA/Lead Program, 246 North High Street, Columbus Ohio, 43215
•Faxed to (614) 752-4157
•E-mailed to lead@odh.ohio.gov
Name of licensed Lead Inspector / Risk Assessor / Clearance Technician
License number
Employer
Phone number
Employer address
Email address
City
State
ZIP
Month and year of reportable activity (one month per form only)
A No activity
Summary Information
1. Property address
OH
Was constructed before 1950?
A Yes
A No
Was a lead hazard found?
Activity performed select only one per line
Reason for activity
A Inspection
A Partial Inspection
A Abatement
A Non-Abatement
A Risk Assessment
A Partial Risk Assessment
A EBL Investigation
A Lead Safe Renovation
A Lead Hazard Screen
A Inspection and Risk Assessment
A Hazard Control Order
A Essential Maintenance Practices
A Clearance Examination
A Owner requested
If Clearance was performed, did clearance area pass? A Yes A No
2. Property address
3. Property address
HEA 5802 7/06
Page _______ of _________
4. Property address
5. Property address
6. Property address
7. Property address
8. Property address
9. Property address
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