In the state of Michigan, there exists a critical mechanism for ensuring the safety and compliance of activities intended to manage and reduce exposure to lead-based paint. Thorough and timely communication with regulatory bodies is made obligatory for any firm engaged in lead abatement work through the Michigan Department of Health and Human Services (MDHHS) form DCH-0654. This document serves as a mandatory notification tool, as stipulated by the Michigan Lead Abatement Act of 1998 and its subsequent amendments. Firms are required to notify the MDHHS' Healthy Homes Section of their intent to commence such work no less than three business days before the work begins. This notification encompasses a broad spectrum of essential information, including the schedule of the abatement activities, contractor and supervisor details, types of lead-based paint assessments to be carried out, and specifics about the site, such as its address, occupancy status, and the nature of the abatement project. The significance of this form does not solely lie in its role as a preliminary step in the abatement process but also in its function as a safeguard for maintaining public health and safety by ensuring lead abatement activities are conducted within the legal framework designed to minimize lead exposure among Michigan residents.
| Question | Answer |
|---|---|
| Form Name | Michigan Form Dch 0654 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Dch 0654_66064_7 michigan lead abatement form dch 0654 |
Notification of Lead Abatement Activity
Any [firm] conducting
All information is required. Incomplete notifications will not be approved.
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Notification Date: |
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Start Date: |
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End Date: |
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Revision #: (for |
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changes) |
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Reason for revision |
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Scheduled work hours:_______________ to_______________ |
⃝ |
Weekends included |
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Contractor Name: |
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MI Certification #: |
C- ______________ |
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Contact Person: |
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Phone #: |
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Certified Lead Abatement |
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MI Certification #: |
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Supervisor for this project: |
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P- ______________ |
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Risk Assessor: |
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MI Certification #: |
P- ______________ |
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Type of |
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⃝ Risk assessment |
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⃝ Inspection |
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⃝ Assumed |
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Building Owner: |
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Owner phone #: |
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Project/Site |
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City: |
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Zip: |
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Address: |
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Apartment numbers: |
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County: |
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Occupancy Status |
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Building Type |
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Occupancy Type |
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⃝ Occupied: |
⃝ Vacant: |
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⃝ Rental |
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(includes temporary |
(abandoned/unoccupied) |
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⃝ |
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⃝ Owner Occupied |
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relocation) |
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⃝ Child occupied facility |
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⃝ Vacant or unknown |
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Housing Agency: (agency funding the project)
Contact Person:
Phone #:
Scope of Work
⃝ Interior ⃝ Exterior
⃝ Encapsulation ⃝ Enclosure ⃝ Component removal ⃝ Paint removal ⃝ Soil
Brief detail of scope of work (replace windows, exterior doors, interior doors, siding, encapsulate baseboards room #4, etc)
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1. Complete form.
2. Return to HHS at least three (3) business days prior to the commencement of abatement work.
3. If project schedule changes, mark the appropriate revision number at the top of the form and send in at least 24 hours prior to change.