Tennessee Alliance for Lead-safe Kids (TALK)
TNLOR0036-08
Childhood Lead Poisoning Awareness Survey

Thank you for taking the time to learn about childhood lead poisoning prevention. Please answer this short survey to help us strengthen our program.

1. Will you have your child under 6 tested for lead exposure?
	Yes
	No
2. Which lead-safe cleaning tips will you use? (check all that apply)
	Wash hands and toys
	Wet wash hard surfaces
	Use a HEPA vacuum
	Remove or wipe shoes before entering house
3. Which home improvements will you use to make your home lead-safe? (check all that apply)
	Wet sand peeling/chipping paint
	Make sure paint is in good condition, cover peeling/chipping paint
	Have your home tested for lead-based paint
	Cover bare soil
4. Will you share what you have learned with friends and family?
	Yes
	No
5. Are you interested in applying for grant funded lead-based paint clean-up for a pre-1978 home?
	Yes
	No
If yes, please provide:
	Name:
	Address:
	City:
	Zip:
	Phone:

For any questions please contact the TALK office at (865) 244-4350 or woodcock@mtsu.edu

Thank you for your efforts to make you family lead-safe!