Designated Asbestos Coordinator Notification, F-00047 (08/2025)

Designated Asbestos Coordinator Notification

K-12 schools are required under Wis. Admin. Code ch. DHS 159 to notify the Department of Health Services of the person who will assure the school follows asbestos requirements. Complete this form annually before October 1 to follow this requirement.

A copy of your completed form will automatically be emailed to the school administrator or superintendent, the designated asbestos coordinator, and the submitter, if different.

Please email DHSAsbestosLead@dhs.wisconsin.gov with any questions.

1. School information

Reporting for a: *This question is required.

School name *This question is required.

School district *This question is required.

Mailing address *This question is required.

Suite or office

City *This question is required.

State *This question is required.

ZIP code *This question is required.

2. School administrator or superintendent *This question is required.

First name

Last name

Email address

3. Designated asbestos coordinator *This question is required.

First name

Last name

Email address

4. Who is completing this form? *This question is required.

Please enter an 'other' value for this selection.

Provide your email address to receive a copy of the completed form. This question requires a valid email address.