Safety Notice FastResponse
Peeling Lead Paint & Window Guards
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Email address (optional)
Enter your Web Response Code
(as displayed on your printed Annual Notice)
Enter the Notice Number above your address
(as displayed on your printed Annual Notice)
Enter your name
Enter the unit number of your property
THE WEB RESPONSE CODE
YOU ENTERED IS
INCORRECT, PLEASE
CHECK AND TRY AGAIN
Please confirm the following information
matches the account pertaining to your form.
Otherwise, please correct the data above.
XX
Yes, this information is correct.
THE EMAIL ADDRESS
YOU ENTERED IS
INCORRECT, PLEASE
CHECK AND TRY AGAIN
PLEASE ENTER A NAME
PLEASE ENTER A UNIT NUMBER
PLEASE ENTER A NOTICE NUMBER
Is there a child 10 years or
younger living at your apartment?
Yes
No
PLEASE CHOOSE JUST 1
(ONE) OF THE OPTIONS
ABOVE BEFORE
PROCEEDING
Does a child 5 years or younger live in the apartment or routinely spend 10 or more hours each week in the apartment?
Yes
No
PLEASE CHOOSE JUST 1
(ONE) OF THE OPTIONS
ABOVE BEFORE
PROCEEDING
I want window guards installed anyway
I have window guards, but they need repair
I do not want window guards installed
Window guards are installed in all windows as required
Window guards are installed but need repair
Window guards are NOT installed in all windows as required
PLEASE CHOOSE JUST 1
(ONE) OF THE OPTIONS
ABOVE BEFORE
PROCEEDING
Please sign your signature below and click ‘Save’
By clicking the ‘FINISH’ button below, I hereby agree that I have understood and completed each and every question on this form and all information provided is accurate and correct.
PLEASE SIGN THE DOCUMENT
ABOVE BEFORE
PROCEEDING
YOU MUST AGREE
TO THE TERMS
ABOVE BEFORE
PROCEEDING
CONTINUE
FINISH
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