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Sample company (fictional) · Lead-Safe RenovationDraft generated Oct 30, 2026
Lead-safe renovation job record
Recorded on site.
Record
Company
Sample company (fictional)
Trade
Lead-Safe Renovation
Job
Recorded on site.
Firm
Firm name
Certifying program
Firm certification number
Firm certification expiry
Avery Lund
EPA
CE-4100
May 18, 2027
Certified renovator
Name
Certificate number
Most recent course date
Training provider
Certificate expiry
Avery Lund
CE-4100
Oct 10, 2026
Training provider 1
Apr 28, 2027
Jordan Pike
CE-4137
Aug 18, 2026
Training provider 2
Apr 28, 2027
On-the-job training record
Worker
Date
Certified renovator who trained
Practices taught
Jordan Pike
Aug 18, 2026
Jordan Pike
Recorded on site.
Sam Okafor
Jun 26, 2026
Avery Lund
Recorded on site.
Avery Lund
Oct 10, 2026
Avery Lund
Recorded on site.
Property
Address
120 Foundry Rd, Springfield
Year built
1701
Type
Single-family
Zero-bedroom dwelling
Yes
Child under six lives or will live here
Yes
Owner-occupied
Yes
Job
Scope of work
Recorded on site.
Exterior painted surface disturbed
1 sq ft
Includes window replacement
Yes
Includes demolition of painted surfaces
Yes
Emergency renovation
Yes
Start date
Sep 30, 2026
Completed on
Sep 30, 2026
Final invoice delivered on
Sep 30, 2026
Assigned certified renovator
Avery Lund
Interior work by room
Room
Painted surface disturbed in this room
Date
North bay
1 sq ft
Oct 10, 2026
Bay 2
3 sq ft
May 4, 2026
Lead determination
Method
Test kit brand and model
Component tested
Location
Result
Lab name and address
Presumed present
KI-4100
Component tested 1
North bay
Positive
120 Foundry Rd, Springfield
Inspector or risk assessor report
KI-4211
Component tested 4
Bay 2
Negative
171 Market St, Springfield
Pre-renovation notice
Recipient
Method
Delivered or mailed on
Owner
Signed hand delivery
Aug 31, 2026
Parents or guardians (child-occupied facility)
Tenant self-certification
Aug 31, 2026
Consents
Client consents are recorded through the client link.
Work practices
Warning signs posted at the work area
Pass
Work area contained so dust and debris stay inside
Pass
No prohibited practices (open-flame burning, high-speed paint removal without HEPA exhaust control, very hot heat guns)
Pass
Waste contained and removed at the end of each day
Pass
Cleaning verification
Room or area
Re-cleans
North bay
1
Bay 2
3
Close out
Visual check: no dust, debris or residue in the work area
Pass
Cleaning verification done by the certified renovator
Pass
Readings
Reading
Value
Result
Cleaning verification card comparison EPA: RRP Program Work Practices (https://www.epa.gov/lead/renovation-repair-and-painting-program-work-practices), checked 2026-10-28
Pass
Pass
Photos
Photos taken on the phone at the job print here, each captioned with what it shows.
Signature
The signature drawn on the phone at the job prints here.