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Lead Exposure Risk Assessment Questionnaire

In addition to the required screening at ages one and two, assessment of risk for high-dose lead exposure should be done at least annually for each child six months to six years of age (up to age 18, if indicated).  These questions serve as a risk assessment tool based on currently accepted public health guidelines.  Children found to be at risk for lead exposure should receive a blood lead test whenever such risk is identified.


Yes No

1.>  Does your child live in or regularly visit a house/building built before 1978 with peeling or chipping paint, or with recent, ongoing or planned renovation or remodeling?

Note:  This could include a day care center, preschool, and the home of a babysitter or a relative.

2.>  Has your family/child ever lived outside the United States or recently arrived from a foreign country?

3.>  Does your child have a brother, sister, housemate or playmate being followed or treated for lead poisoning?

4.>  Does your child frequently put things in his/her mouth such as toys, jewelry, or keys? Does your child eat non-food items (pica)?

Note:  This may include toys or jewelry products that have been specifically recalled by the Consumer Products Safety Commission (CPSC) due to identification of unsafe levels of lead.

5.>  Does your child frequently come in contact with an adult whose job or hobby involves exposure to lead?

Note:  Jobs such as house painting, renovations, construction, welding or pottery making. Hobby examples are making stained glass or pottery, fishing, making firearms and collecting lead figurines.

6.>  Does your child live near an active lead smelter, battery recycling plant, or another industry likely to release lead or does your child live near a heavily traveled major highway where soil and dust may be contaminated with lead?

Note:  May need to alert parent/caregiver if such an industry is local. Ask any additional questions that may be specific to situations in a particular community.

If the answer to any of the above questions is YES, then the child is considered to be at risk of high dose lead exposure and should be screened with a blood lead test.