Asbestos and Lead Regulatory Program Tip Form

Asbestos and Lead Handling Concern

Thank you for contacting the Vermont Department of Health to report a concern about the possible unsafe handling of asbestos or lead containing materials. Please provide detailed information to allow the Department to determine the appropriate follow-up.

We understand your desire for privacy. You may skip the "Your Contact Information" section below if you choose to remain anonymous. However, we sometimes have questions about the concerns we investigate. For this reason, please consider providing us at least your phone number or email address.

Asbesto or Lead Complaint

Required fields are marked by an asterisk (*).

1. Your Contact Information

First Name

Last Name

City

State

Email Address This question requires a valid email address.

Phone Number This question requires a valid number format.

2. On which date did you observe the concern?: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

3. Approximate time you observed the concern:

4. Please identify the type of property this concern is for: *This question is required.

Please enter an 'other' value for this selection.

5. Please provide the location including street address and town of your concern: *This question is required.

6. Please provide the name of the property owner if known:

7. If this observation is related to work being performed, what is the name of the contractor? Providing the contractor's name or business name will help us contact the contractor.

8. This concern is related to: *This question is required.

9. Please describe your concern and provide as much detail as you can: *This question is required.

10. Do you have pictures or other documents to support your concern? *This question is required.

Please upload photos or other documents that support your concern. The largest file size that can be uploaded in this survey is 500KB. If your photos are too large, reduce the file size to upload them. If you are unable to upload the photos here, email them to ALRP@vermont.gov. Be sure to include the property address in your email.

File: {{filename}} delete

Please upload additional photos or other documents that support your concern (max file size is 500KB):

File: {{filename}} delete

Please upload additional photos or other documents that support your concern (max file size is 500KB):

File: {{filename}} delete

11. Please provide any additional comments you have: