Illinois Lead Program Forms
State of Illinois Certificate of Child Health Examination
- En Español
- PDF
Lead Contractor
Application - PDF - Application Instructions
Lead Contractor 7-day Notice Form - PDF
Lead Contractor Application Checklist - PDF
Lead Supervisor, Inspector, Risk Assessor,
Application - PDF - Application Instructions
Lead License Renewal Application - PDF
Lead Worker Application or
Spanish - PDF - Application Instructions
Training Course Application - PDF - Application Instructions
Training Class Roster - PDF
Training Course Notification Form - PDF
Third Party Examination Application - PDF
Third Party Examination Dates & Locations
Public Information Disclosure Form - PDF
Childhood Lead Risk Questionnaire - En Español - En français - PDF
Guidelines for Lead Risk Evaluation and Blood Lead Testing - PDF
Medical Childhood Lead Risk Assessment Questionnaire - Excel (Longitudinal record for physician office use)
Public Health Nurse
Home Lead Assessment Form - PDF
Pediatric Lead Poisoning High-Risk ZIP Code Areas - En Español - PDF
Lead, Blood Analysis Test Request
Report of Blood Lead Test Result - Fillable PDF
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