Lead Sample Collection Kit
Consent Form
The Notre Dame Lead Innovation Team is a group of researchers studying lead in homes and the environment in Indiana. Lead is a toxic material that usually comes from old paint or lead-contaminated soil. It is particularly more harmful for babies and young children. This form gives us permission to test samples that you collect from your home for lead. The form describes the testing process and how we will use the test results.
What you will do and what we will do: After you sign this consent form, you will receive a Lead Sample Collection Kit. The kit has directions and our website has videos with instructions for collecting samples of paint, soil, and dust from your home. After you collect the samples, return the kit to one of the drop-off locations. We will test each sample for lead using an instrument that can detect lead in solid materials. We will send you a report within 4 weeks. If there are any elevated results indicating lead hazards in the home, we recommend you contact the St. Joseph County Health Department (SJCHD) Environmental Division for a free and comprehensive Home Lead Risk Assessment. To help make it easier to schedule a Home Lead Risk Assessment, we would like to share elevated results with SJCHD. You may indicate below whether or not you would like your results shared with SJCHD. All of these services are free.
Privacy and Confidentiality: We will use combined results from many homes to understand where lead still exists in our community. A risk of participating in this study is that someone outside the study might see your name, address, and the test results from your residence. Your information will be protected as best as possible from people outside the study team, and any information we publish or present about the study will not include identifiable information about any study participants. When the data analysis is done, we will erase all personally identifiable information about study participants.
Risks: If you are a homeowner in the state of Indiana, and you know that your home has lead paint, you must disclose this information when selling or renting your house, and this could affect the value of your home. Renters do not have this obligation.
Benefits: You could learn important health and safety information about your residence. If there is a potential hazard from lead in the home, we will provide information about steps you can take to reduce lead exposure, how you can learn more about where lead is present in your home, and how you can ensure that people and pets living in the home are safe.
For more information, please visit https://leadinfo.nd.edu/lead-test-kits/nd-lit-test-kit-sampling-videos/ or contact Heidi Beidinger, hbeiding@nd.edu, or Chris Knaub, cknaub@nd.edu
I give my permission for the Notre Dame Lead Innovation Team to test soil, dust, and paint samples from my residence
Please Sign below