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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

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

3. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

HEA 5802 7/06

Lead Monthly Summary

Page _______ of _________

 

4. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

5. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

6. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

7. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

8. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

9. Property address

City

State

OH

ZIP

Was constructed before 1950?

A Yes

A No

Was a lead hazard found?

A Yes

A No

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

HEA 5802 7/06

Document Properties

Fact Name Detail
Purpose The HEA 5802 form is used to summarize lead inspection, risk assessment, and clearance examination activities for properties in Ohio.
Submission Deadline This form must be submitted by the 15th of each month to report activities from the previous month.
No Activity Reporting If no activities occurred in a month, the user should check the “no activity” box on the form.
Separate Entries Each property address and activity must be reported on a separate line, ensuring clarity in reporting.
Lead Hazard Indication If a property fails a clearance examination, the user must indicate “Yes” for the presence of a lead hazard.
Governing Law The form is governed by rule 3701-32-15 of the Ohio Administrative Code, which outlines lead hazard reporting requirements.
Submission Methods Forms can be submitted via first-class mail, fax, or email to the Ohio Department of Health.
Information Completeness Incomplete forms will be returned, so all sections must be filled out accurately.
Property Age Inquiry The form includes a question about whether the property was constructed before 1950, as older properties are more likely to have lead hazards.
Activity Types The form allows for various activity types to be selected, including inspections, risk assessments, and clearance examinations.

Documents used along the form

The Ohio HEA 5802 form serves as a monthly summary for lead inspection and risk assessment activities. Alongside this form, several other documents may be required to ensure compliance with state regulations regarding lead hazards. Below is a list of related forms and documents commonly used in conjunction with the HEA 5802.

  • Lead Inspection Report: This document details the findings from a lead inspection, including the specific locations tested, the results of those tests, and any lead hazards identified. It serves as a critical record for property owners and regulatory agencies.
  • Risk Assessment Report: This report evaluates the potential risk of lead exposure in a property. It includes information on lead sources, exposure pathways, and recommendations for remediation or management of identified hazards.
  • Clearance Examination Report: After lead hazard control activities, this report confirms whether the property meets clearance standards. It indicates if lead levels are acceptable and if the area is safe for occupancy.
  • Abatement Notification Form: This form is used to notify relevant authorities about planned lead abatement activities. It outlines the scope of work, timelines, and safety measures to be implemented during the abatement process.
  • Georgia Quitclaim Deed Form: This legal document, available at smarttemplates.net, facilitates the transfer of property ownership in Georgia without any warranties regarding the title's clarity, making it useful for family transactions and resolving title issues.
  • Essential Maintenance Practices (EMP) Plan: This document outlines the ongoing maintenance activities required to manage lead hazards in a property. It includes routine inspections and maintenance tasks to minimize the risk of lead exposure.
  • Owner's Acknowledgment Form: This form is signed by property owners to acknowledge receipt of inspection results and any recommended actions. It serves as a record of communication between inspectors and property owners.

Each of these documents plays a vital role in the overall process of managing lead hazards in Ohio. They help ensure that properties are safe for occupants and that all necessary regulatory requirements are met.

Guidelines on Filling in Ohio Hea 5802

Completing the Ohio HEA 5802 form involves several steps to ensure accurate reporting of lead inspection and risk assessment activities. It is important to provide complete information as incomplete forms may be returned. The form should be submitted by the 15th of each month for the previous month’s activities. If no activities were performed, the appropriate box should be checked.

  1. Obtain the Ohio HEA 5802 form from the Ohio Department of Health website or your employer.
  2. Fill in the name of the licensed Lead Inspector, Risk Assessor, or Clearance Technician at the top of the form.
  3. Enter the license number, employer name, phone number, employer address, email address, city, state, and ZIP code.
  4. Specify the month and year of the reportable activity. Remember, only one month can be reported per form.
  5. If no activities were performed during the month, check the “No activity” box.
  6. For each property address, complete a separate line. Include the property address, city, state, and ZIP code.
  7. Indicate if the property was constructed before 1950 by checking “Yes” or “No.”
  8. Answer the question “Was a lead hazard found?” with “Yes” if the property failed the clearance examination, or “No” if it passed.
  9. Select the activity performed from the provided options. Only one activity can be selected per line.
  10. If a clearance examination was performed, indicate whether the clearance area passed by checking “Yes” or “No.”
  11. Repeat steps 6 through 10 for each additional property, up to a maximum of nine properties.
  12. Review the completed form for accuracy and completeness before submission.
  13. Submit the form via one of the following methods: by first-class mail, fax, or email.

Common mistakes

Completing the Ohio HEA 5802 form can be challenging, and mistakes can lead to delays or complications. One common error is failing to submit the form by the 15th of each month. Timeliness is crucial. If the form is submitted late, it may not be processed, which can affect compliance and reporting.

Another frequent mistake involves incomplete information. The form must be filled out in its entirety. If any sections are left blank, it will be returned for correction. This can cause unnecessary delays and frustration. Always double-check that all required fields are completed before submission.

Many individuals also neglect to enter separate lines for each property address and activity. For instance, if a clearance examination fails and then passes upon reexamination, both results must be documented on separate lines. Failing to do so can lead to inaccurate records and potential misunderstandings regarding the property's status.

Additionally, some may incorrectly answer the question regarding whether a lead hazard was found. It is essential to indicate “Yes” if the property failed the clearance examination and “No” if it passed. Misrepresenting this information can have serious implications for health and safety compliance.

Lastly, the method of submission can be a source of confusion. The form can be mailed, faxed, or emailed. However, individuals sometimes overlook this detail and fail to choose the most appropriate method for their situation. Understanding the submission options can ensure that the form reaches the Ohio Department of Health in a timely manner.

FAQ

  1. What is the purpose of the Ohio HEA 5802 form?

    The Ohio HEA 5802 form is used to report lead inspection, risk assessment, and clearance examination activities conducted in the previous month. It ensures that the Ohio Department of Health is informed about lead hazard assessments and related activities in a timely manner.

  2. When is the HEA 5802 form due?

    This form must be submitted by the 15th of each month. If no activities were performed during the month, you should check the “no activity” box on the form.

  3. How should I fill out the HEA 5802 form?

    Complete all sections of the form. Each property address and activity should be entered on a separate line. For example, if a clearance examination failed and then passed upon reexamination, both outcomes should be documented on separate lines.

  4. What should I indicate if a lead hazard is found?

    If a property fails the clearance examination, you must indicate “Yes” to the question regarding whether a lead hazard was found. Conversely, if the property passes, answer “No” to that question.

  5. What methods can I use to submit the HEA 5802 form?

    You can submit the form in one of the following ways:

    • By first-class mail to: Ohio Department of Health, DQA/Lead Program, 246 North High Street, Columbus, Ohio, 43215
    • By fax at (614) 752-4157
    • By email to lead@odh.ohio.gov
  6. What information do I need to provide about the property?

    For each property, you must provide the address, city, state, ZIP code, and whether it was constructed before 1950. Additionally, indicate if a lead hazard was found and the type of activity performed.

  7. What happens if I do not complete all parts of the form?

    If any information is missing, the form will be returned. It is essential to ensure that all required fields are filled out accurately to avoid delays in processing.