Risk Assessment Questionnaire
If you answer yes to any of the following questions,
it is in the best interest of your child to have a lead screen.
it is in the best interest of your child to have a lead screen.
1. Is the child between the ages of 1-6 and eligible for or receiving benefits from WIC and/or Medicaid?
2. Does the child live in or regularly visit a ZIP code determined to be at high risk for lead poisoning? (46802, 46806, 46807, 46808)
3. Does the child live in or regularly visit a home or day care center built before 1978 with peeling and/or chipping paint?
4. Does the child have a sibling or playmate being treated for lead poisoning?
5. Does the child live with an adult whose job or hobby involves exposure to lead? (Includes home repairs, auto repairs, furniture refinishing, firing ranges, casting lead fishing sinkers, and boat repairs.)
6. Does the child live near a busy street, an active lead smelter, or other industry likely to release lead?
7. Does the family use imported or glazed ceramics for food preparation, storage or dinnerware? Are there any home remedies used such as tahanakha?
8. Does the child have medical findings consistent with lead poisoning? (This includes any development delay, speech delay, anemia, hyperactivity, stomach aches, trouble with being potty trained or undiagnosed seizures.)
2. Does the child live in or regularly visit a ZIP code determined to be at high risk for lead poisoning? (46802, 46806, 46807, 46808)
3. Does the child live in or regularly visit a home or day care center built before 1978 with peeling and/or chipping paint?
4. Does the child have a sibling or playmate being treated for lead poisoning?
5. Does the child live with an adult whose job or hobby involves exposure to lead? (Includes home repairs, auto repairs, furniture refinishing, firing ranges, casting lead fishing sinkers, and boat repairs.)
6. Does the child live near a busy street, an active lead smelter, or other industry likely to release lead?
7. Does the family use imported or glazed ceramics for food preparation, storage or dinnerware? Are there any home remedies used such as tahanakha?
8. Does the child have medical findings consistent with lead poisoning? (This includes any development delay, speech delay, anemia, hyperactivity, stomach aches, trouble with being potty trained or undiagnosed seizures.)
The Allen County Childhood Lead Poisoning Prevention Program (CLPP) is a collaborative project of the Fort Wayne-Allen County Department of Health and the St. Joseph Community Health Foundation
For more information, contact us at the Lead Info Hotline (260)-449-8600.
