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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 - PDF

Public Information Disclosure Form - PDF

Childhood Lead Risk Assessment Questionnaire and GuidelinesEn Español - En français - 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 AreasEn Español - PDF

Lead, Blood Analysis Test Request

Report of Blood Lead Test Result - Fillable PDF