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									                                                                                                                                                                                                                                          HUD Office of Healthy Homes and Lead Hazard Control



Healthy Homes Toolbox
The following tools have been collected from various organizations, including HUD Office of Healthy Homes and Lead Hazard Control (OHHLHC) grantees. They are arranged by five major subjects:
- Program Development and Start-up
- Specifications and Guidelines
- Assessment
- Evaluation, and
- Training and Outreach

In addition, these tools have been categorized within at least one of ten additional categories shown in the top row.

Tools are in one of three locations:
--On the web with a direct web link provided
--On the Healthy Homes Electronic Exchange. The Healthy Homes Electronic Exchange is a web site where grantees, partners, and other stakeholders can ask questions, share tools and ideas, learn
about other programs, and support the HH community. To access the tools through the Exchange, click on the link provided and choose the "View Discussion" option. Then, choose the search option
and type in all or part of the title (often using, say, "owner" to find the "owner-occupant notification forms" is more successful, as the titles occasionally change slightly.) Be sure to search "All"
documents, as postings are automatically archived after six months. Alternatively, a user can sort the Exchange postings by date and look under the date offered in the Organization/Source column.
--Available only through hard copy

                                                                                                                                                                                                                             Categories




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                 #01001   Boston Intake/Screening     Boston Medical Center    Three-page questionnaire explains how the intervention process              http://www.hud.gov/offices/lead/
Prgm Devt &               form                        HH Grantee (also on HHI will work and determines if family is eligible for the study.                hhi/4A_Boston_Intake_Screenin
Startup                                               website)                                                                                             g.pdf                            Y         X                 X                  X
                 #01024   Indoor Environmental        Fungal Research Group Screening questionnaire identifies possible health complaints or               http://www.fungalresearchgroup
Prgm Devt &               Quality-Medical Screening                            problems that may be associated with work or home environmental             .com/new%20questionaire.htm
Startup                   Questionnaire                                        exposures.                                                                                                   N         X
                 #01025   Model Resident -            The Community            3 page form available in .pdf “This form is a plain language                http://www.cehrc.org/exposing/r
                          Organization Agreement      Environmental Health     agreement between advocates undertaking projects to investigate             esidents/modelagree.cfm
Prgm Devt &                                           Resource Center          housing-related health hazards and residents of homes where
Startup                                               (CEHRC) website          investigations are being formed.”                                                                               N                        X                  X
                 #01076   Working with Community      Community Tool Box       This chapter is from a general guide geared toward community                http://ctb.lsi.ukans.edu/tools/EN
                          Residents/ Recruitment      Web site - Link from The development organizations. Covers recruiting and training of                /chapter_1011.htm
                          (Chapter 11. Recruiting and Community                volunteers.
Prgm Devt &               Training Volunteers)        Environmental Health
Startup                                               Resource                                                                                                                              N                                              X       X
                 #01098   Intake Form                 Boston Medical Center    3 pages                                                                     Boston Medical Center Grantee
Prgm Devt &                                           HH Grantee                                                                                           Binder (hard copy available
Startup                                                                                                                                                    from ICF)                        Y         X
                 #01099   Consent Form                  Boston Medical Center      7 pages. Explains responsibilities to potential participants, as well   Boston Medical Center Grantee
Prgm Devt &                                             HH Grantee                 as risks, benefits, and confidentiality.                                Binder (hard copy available
Startup                                                                                                                                                    from ICF)                        Y                           X
                 #01100   Owner-Occupant                National Center for        10 pages. Notification for owner-occupants explaining the               http://icfhosting.com/hh/healthy
                          Notification Forms            Healthy Housing--          environmental results for samples collected in their                    h.nsf/
                                                        Providence Healthy         homes/properties . The letter summarizes lead dust wipe, dust
                                                        Homes Study (posted to     mite allergen vacuum (der f1 and der p1) and cockroach allergen
Prgm Devt &                                             the Exchange 5/6/2003)     (bla g1 and some limited bla g2) results for samples collected pre-
Startup                                                                            and immediate post-intervention.                                                                     Y                                    X
                 #01101   Rental Property Owner         National Center for        8 pages. Notification for the rental property owners explaining the http://icfhosting.com/hh/healthy
                          Notification Forms            Healthy Housing--          environmental results for samples collected in their                h.nsf/
                                                        Providence Healthy         homes/properties . The letter summarizes lead dust wipe, dust
                                                        Homes Study (posted to     mite allergen vacuum (der f1 and der p1) and cockroach allergen
Prgm Devt &                                             the Exchange 5/6/2003)     (bla g1 and some limited bla g2) results for samples collected pre-
Startup                                                                            and immediate post-intervention.                                                                     Y                                    X




      Last updated: May 5, 2003                                                                                                                                Healthy Homes Toolbox                                                                                                  Page 1
                                                                                                                                                                                                                                    HUD Office of Healthy Homes and Lead Hazard Control




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                #01102   Tenant Notification Forms   National Center for         11 pages. Notification for tenants explaining the environmental      http://icfhosting.com/hh/healthy
                                                     Healthy Housing--           results for samples collected in their homes/properties . The letter h.nsf/
                                                     Providence Healthy          summarizes lead dust wipe, dust mite allergen vacuum (der f1 and
                                                     Homes Study (posted to      der p1) and cockroach allergen (bla g1 and some limited bla g2)
Prgm Devt &                                          the Exchange 5/6/2003)      results for samples collected pre- and immediate post-intervention.
Startup                                                                                                                                                                                   Y                            X
                #01103   Asthmatic Home Education Erie County grantee            1-page checklist on home visit                                        http://icfhosting.com/hh/healthy
Prgm Devt &              Visit Record               (posted to the Exchange                                                                            h.nsf/
Startup                                             6/11/03)                                                                                                                              Y                                          X
                #01104   Mount Sinai Hospital       Mount Sinai School of        4-page HIPAA authorization form.                                      http://icfhosting.com/hh/healthy
                         Research Subject           Medicine grantee (posted                                                                           h.nsf/
Prgm Devt &              Authorization              to the Exchange
Startup                                             6/17/2003)                                                                                                                            Y                       X
                #01105   IRB Consent Form           Mount Sinai School of        6-page information document and IRB consent form.                     http://icfhosting.com/hh/healthy
                                                    Medicine grantee (posted                                                                           h.nsf/
Prgm Devt &                                         to the Exchange
Startup                                             6/17/2003)                                                                                                                            Y                       X
                #01106   Mount Sinai Referral Form Mount Sinai School of         2-page referral form.                                                 http://icfhosting.com/hh/healthy
                                                    Medicine grantee (posted                                                                           h.nsf/
Prgm Devt &                                         to the Exchange
Startup                                             6/17/2003)                                                                                                                            Y
                #01107   Mount Sinai                Mount Sinai School of        1-page intake/qualification form.                                     http://icfhosting.com/hh/healthy
                         Intake/Qualification Form  Medicine grantee (posted                                                                           h.nsf/
Prgm Devt &                                         to the Exchange
Startup                                             6/17/2003)                                                                                                                            Y
                #02007   Cleaning Guidelines: ZAP   HHI Website                  One-page with cleaning suggestions to control mites/dust,             http://www.hud.gov/offices/lead/
                         Asthma Cleaning Guidelines                              cockroaches, and mold/mildew.                                         hhi/4D_ZAPAsthmaCleaningGui
Specs and                – Development Group                                                                                                           delines.pdf
Guidelines               Recommendations                                                                                                                                                N                     X
                #02008   Effective Environmental    HHI Website                  9 pages of research-oriented guidelines on controlling allergens      http://www.hud.gov/offices/lead/
Specs and                Control Methods: What                                                                                                         hhi/4E_EffectiveEnvironmental
Guidelines               Works and What Doesn‟t                                                                                                        ControlMethods.pdf               N                     X                              X
                #02009   Master Mold Specs          Cuyahoga County (also        27 pages – work specs covering interior and exterior methods to       http://www.hud.gov/offices/lead/
Specs and                                           on HHI Website)              control or remove mold.                                               hhi/4F_Cuyahoga_MASTERMO
Guidelines                                                                                                                                             LDSPEC3.pdf                      Y                     X
                #02010   Mold Clean-up Guidelines    micro ecologies inc. (also 6-pages of mold information geared toward residents. Includes a        http://www.hud.gov/offices/lead/
Specs and                for Residents               on HHI Website)            mold-cleaning protocol.                                                hhi/4G_microecologiesInc.pdf
Guidelines                                                                                                                                                                              N                     X                              X
                #02011   Physical Interventions      Harvard School of Public    2-page table that lists possible interventions and links the          Ihttp://www.hud.gov/offices/lead
Specs and                                            Health (also on HHI         intervention to research demonstrating their benefit. Also includes   /hhi/4H_Physical_Interventions.
Guidelines                                           Website)                    the approximate cost of interventions.                                pdf                              Y                     X
                #02012   Protecting Small Children   John Roberts,               3-page leaflet/handout that discusses cleaning methods residents      http://www.hud.gov/offices/lead/
Specs and                from Toxins in House Dust   Engineering Plus (also on   can use to reduce dust. Focuses on carpets and furnishings.           hhi/4I_Protect_Small_Children.
Guidelines                                           HHI Website)                                                                                      pdf                              N                     X
                #02013   Cuyahoga County Urban       Cuyahoga County (also       3-pages. Identifies standards for operating the program in            http://www.hud.gov/offices/lead/
                         Mold & Moisture Program     on HHI Website)             Cuyahoga County.                                                      hhi/4J_Cuyahoga_Stds_Guideli
                         (Draft 12/1/00 PART A:                                                                                                        nes.pdf
Specs and                STANDARDS &
Guidelines               GUIDELINES)                                                                                                                                                  Y                       X
                #02023   Fungal Abatement Safe       Environmental Health and    Intended for facilities management personnel. Covers procedures http://www.dehs.umn.edu/iaq/so
Specs and                Operating Procedure         Safety, University of       for projects and job tasks that require the removal of mold bearing p.html
Guidelines                                           Minnesota                   building materials.                                                                                  N                       X
                #02062   Contractor Procedures       City of Long Beach          2-pages of instructions for remediating mold, rodents, etc.         http://icfhosting.com/hh/healthy
Specs and                                            (Posted to Exchange                                                                             h.nsf/
Guidelines                                           4/9/2002)                                                                                                                        Y                       X




     Last updated: May 5, 2003                                                                                                                             Healthy Homes Toolbox                                                                                                Page 2
                                                                                                                                                                                                                                     HUD Office of Healthy Homes and Lead Hazard Control




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                #02063   List of Contractor Tools    City of Long Beach         2-pages of examples of tools, equipment and materials that can          http://icfhosting.com/hh/healthy
Specs and                                            (Posted to Exchange        assist in completing HHI work lists.                                    h.nsf/
Guidelines                                           4/9/2002)                                                                                                                             Y                   X
                #02064   Extensive Cleaning          City of Long Beach         2-pages. Seems geared for staff or contractors. Includes                http://icfhosting.com/hh/healthy
Specs and                Procedures                  (Posted to Exchange        instructions on treating carpets, walls, bare floors, cabinets, etc.    h.nsf/
Guidelines                                           4/9/2002)                                                                                                                             Y                   X
                #02065   Contractor – Intervention   City of Long Beach         2-pages of instructions and procedures for treating apartments in       http://icfhosting.com/hh/healthy
Specs and                Instructions                (Posted to Exchange        this HHI program.                                                       h.nsf/
Guidelines                                           4/9/2002)                                                                                                                             Y                   X
                #02075   Guidelines on Assessment New York City                 Guidelines from NYC Dept of Health “This document revises and           http://www.ci.nyc.ny.us/html/doh
                         and Remediation of Fungi in Department of Health &     expands the original guidelines to include all fungi (mold). …. It is   /html/epi/moldrpt1.html
                         Indoor Environments         Mental Hygiene, Bureau     intended for use by building engineers and management, but is
                                                     of Environmental &         available …to anyone concerned about fungal contamination.”
Specs and                                            Occupational Disease
Guidelines                                           Epidemiology                                                                                                                          N               X   X
                #02084   Treatment Menus             Cuyahoga County HH         Details options for treating moisture hazards.                          Cuyahoga County Grantee
Specs and                                            Grantee                                                                                            Binder (hard copy available
Guidelines                                                                                                                                              from ICF)                          Y                   X
                #02092   Environmental Sampling        Bedford Stuyvesant HH    20 pages – covers lead-based paint, mold, and allergen                  Bedford Stuyvesant Grantee
Specs and                and Evaluation Protocols      Grantee                  assessment.                                                             Binder (hard copy available
Guidelines                                                                                                                                              from ICF)                          Y               X
                #02093   Remediation Protocols         Bedford Stuyvesant HH    25 pages of protocols used in the project                               Bedford Stuyvesant Grantee
Specs and                                              Grantee                                                                                          Binder (hard copy available
Guidelines                                                                                                                                              from ICF)                          Y                   X
                #02103   Lead and Healthy Homes        Providence HH Grantee    Contains a range of instructions, forms, and checklists – most are      Providence Grantee Binder
Specs and                Rehab Specialist Project                               associated with the lead portion of the program, but some are           (hard copy available from ICF)
Guidelines               Procedures                                             healthy home specific.                                                                                     Y           X   X   X   X                  X
                #02104   Wisconsin Healthy Homes     Wisconsin HH Grantee       One page for Allergy Skin Test with educational component.              http://icfhosting.com/hh/healthy
Specs and                Initiative Skin Test Record (posted to the Exchange                                                                            h.nsf/
Guidelines                                           6/02/2003)                                                                                                                            Y                                X
                #02105   Mount Sinai Environmental Mount Sinai School of        Six pages of environmental review information, including problem        http://icfhosting.com/hh/healthy
                         Review                      Medicine grantee (posted   areas, intervention activities, products provided, referrals, and       h.nsf/
Specs and                                            to the Exchange            statute authority reference.
Guidelines                                           6/17/2003)                                                                                                                            Y               X
                #02106   Extended Intervention Form Mount Sinai School of       2-page extended intervention form.                                      http://icfhosting.com/hh/healthy
                                                     Medicine grantee (posted                                                                           h.nsf/
Specs and                                            to the Exchange
Guidelines                                           6/17/2003)                                                                                                                            Y                   X
                #02107   Standard Intervention       Mount Sinai School of      7-page intervention checklist.                                          http://icfhosting.com/hh/healthy
                         Activities Checklist        Medicine grantee (posted                                                                           h.nsf/
Specs and                                            to the Exchange
Guidelines                                           6/17/2003)                                                                                                                            Y                   X
                #02108   Bi-Monthly Telephone        Mount Sinai School of      2-page script/form for the bi-monthly telephone call with resident.     http://icfhosting.com/hh/healthy
                         Contact form                Medicine grantee (posted                                                                           h.nsf/
Specs and                                            to the Exchange
Guidelines                                           6/17/2003)                                                                                                                            Y      X            X
                #03001   Wisconsin Healthy Homes Wisconsin HH Grantee           3-page questionnaire on asthma                                          http://icfhosting.com/hh/healthy
                         Initiative Asthma Screening (posted to the Exchange                                                                            h.nsf/
Assessment               Questionnaire               6/02/2003)                                                                                                                            Y      X
                #03002   Wisconsin Healthy Homes Wisconsin HH Grantee           Healthcare Utilization form for asthma.                                 http://icfhosting.com/hh/healthy
                         Asthma Healthcare           (posted to the Exchange                                                                            h.nsf/
Assessment               Utilization Form            6/02/2003)                                                                                                                            Y      X
                #03003   Wisconsin Healthy Homes Wisconsin HH Grantee           Dust Mite Cover Sizing Cards.                                           http://icfhosting.com/hh/healthy
                         Initiative Dust Mite Cover  (posted to the Exchange                                                                            h.nsf/
Assessment               Sizing Cards                6/02/2003)                                                                                                                            Y               X




     Last updated: May 5, 2003                                                                                                                              Healthy Homes Toolbox                                                                                                Page 3
                                                                                                                                                                                                                                       HUD Office of Healthy Homes and Lead Hazard Control




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                #03004   Healthy Homes Checklist      HHI Website                12-page .pdf file includes questionnaire for family on health          http://www.hud.gov/offices/lead/
                                                                                 conditions and house structure and assessment forms for each           hhi/4B_Boston_HHI_Checklist.p
Assessment                                                                       room of the house.                                                     df                               N         X                                    X
                #03005   Pollution Source Survey      Building Performance       Six-page survey on pollution and ventilation.                          http://www.hud.gov/offices/lead/
                                                      Center, Washington State                                                                          hhi/4C_NewPOLLUTION%20S
                                                      (also on HHI Website)                                                                             URVEYv3_.pdf
Assessment                                                                                                                                                                               Y              X   X
                #03026   CROSS-HAZARD                 The Community              Several pdf downloads, including a report form for visual surveys      http://www.cehrc.org/tools/index
                         ASSESSMENT TOOLS:            Environmental Health       and instructions. The web site also includes forms for a floor plan    .cfm
                         Visual Survey                Resource Center            and site plan.
Assessment                                            (CEHRC) website                                                                                                                       N           X
                #03027   CROSS-HAZARD                 The Community              Two pdf downloads – report and instructions for taking samples.        http://www.cehrc.org/tools/index
                         ASSESSMENT TOOLS:            Environmental Health                                                                              .cfm
                         Sampling Results Report      Resource Center
Assessment                                            (CEHRC) website                                                                                                                       N               X   X        X              X
                #03028   ASSESSMENT TOOLS             The Community              Includes background materials on lead dust, a decisions guide,         http://www.cehrc.org/tools/lead/l
                         FOR: Lead Dust               Environmental Health       sampling instructions, sampling checklist, and chain of custody.       eaddust/index.cfm
                                                      Resource Center            (Some are pdf files, the rest are from the web page.)
Assessment                                            (CEHRC) website                                                                                                                       N               X   X                               X
                #03030   ASSESSMENT TOOLS             The Community              Includes background materials on lead contamination in soil, a       http://www.cehrc.org/tools/lead/l
                         FOR: Lead in Soil            Environmental Health       decision guide, sampling instructions, sampling checklist, and chain eadsoil/index.cfm
                                                      Resource Center            of custody.
Assessment                                            (CEHRC) website                                                                                                                       N               X   X                               X
                #03031   ASSESSMENT TOOLS             The Community              Background materials on cockroaches not yet available, but             http://www.cehrc.org/tools/cock
                         FOR: Cockroaches             Environmental Health       includes decision guide, sampling instructions, sampling checklist,    roaches/index.cfm
                                                      Resource Center            and a report form.
                                                      (CEHRC) website
Assessment                                                                                                                                                                                  N               X   X        X
                #03032   HOME ASSESSMENTS:            EnviRN                     About 6 pages --- “This checklist was developed at the University      http://envirn.umaryland.edu/Kell
                         Environmental Health                                    of Maryland School of Nursing Environmental Health Education           ogg%20Curriculum/1_HPDP_F
                         Assessment Guide for a                                  Center for identifying potential environmental health hazards in the   amily_Assessment.pdf
Assessment               Home and Family                                         home."                                                                                                     N      X    X                               X
                #03033   Moisture Audit Tool          Environmental Health       14 pages - pdf - Moisture audit tool developed by Environmental        http://icfhosting.com/hh/healthy
                                                      Watch (Posted to           Health Watch and Housemender.                                          h.nsf/
Assessment                                            Exchange 5/1/2002)                                                                                                                    Y           X       X                  X    X
                #03034   Protocol for sampling        Posted to Exchange         3 pages – excerpted from larger file (ref number #03035) with          http://icfhosting.com/hh/healthy
                         allergens – (short)          6/25/2002                  slight modifications. Protocol for sampling allergens in house dust.   h.nsf/
                                                                                 This protocol was used in the HUD/NIEHS National Survey of Lead
                                                                                 and Allergens in Housing, and was adapted from the Inner City
Assessment                                                                       Asthma Study (ICAS).                                                                                       N               X   X
                #03035   Protocol for sampling        Posted to Exchange         About 15 pages. Protocol for sampling allergens in house dust,         HH Grantee Exchange (HUD –
                         allergens – (long)           6/25/2002                  from a training manual chapter for field staff in the HUD/NIEHS        Inner City Asthma Study)
                                                                                 National Survey of Lead and Allergens in Housing (adapted from
Assessment                                                                       the Inner City Asthma Study (ICAS)).                                                                       N               X   X
                #03038   Visual Assessment              City of Long Beach       12 page assessment form used by the City of Long Beach for their       http://icfhosting.com/hh/healthy
                                                        (Posted to Exchange      HH initiative program.                                                 h.nsf/
Assessment                                              4/9/2002)                                                                                                                           Y           X
                #03040   Injury and Asthma              Wisconsin (Posted to     Two-page test of caregiver‟s knowledge of asthma, including        http://icfhosting.com/hh/healthy
Assessment               Knowledge Tests                Exchange 4/16/2002)      symptoms and triggers.                                             h.nsf/                                  Y      X                                    X
                #03042   Injury risk knowledge test     Wisconsin (Posted to     Two-page form to test general knowledge of dangers in the home.    http://icfhosting.com/hh/healthy
Assessment                                              Exchange 4/16/2002)                                                                         h.nsf/                                  Y      X                                    X
                #03043   Healthcare utilization history Wisconsin (Posted to     One-page form to record child‟s history with injuries.             http://icfhosting.com/hh/healthy
Assessment                                              Exchange 4/16/2002)                                                                         h.nsf/                                  Y      X
                #03044   Brief Asthma Screening         Wisconsin (Posted to     One-page form for parents to record information on child‟s asthma, http://icfhosting.com/hh/healthy
Assessment               Questionnaire                  Exchange 4/16/2002)      including family history and environment conditions.               h.nsf/                                  Y      X




    Last updated: May 5, 2003                                                                                                                               Healthy Homes Toolbox                                                                                                  Page 4
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                #03045   Injury Screening            Wisconsin (Posted to         Four-page (54 questions) on home conditions that prevent home          http://icfhosting.com/hh/healthy
Assessment               Questionnaire               Exchange 4/16/2002)          injuries.                                                              h.nsf/                           Y      X
                #03046   Dwelling Unit Assessment    Erie County (Posted to       9 page Word doc that includes checklists and risk degree               http://icfhosting.com/hh/healthy
                         Tool                        Exchange 5/9/2002)           assessments for dwelling units as well as adjacent structures and      h.nsf/
Assessment                                                                        common areas.                                                                                           Y           X
                #03047   Asthma Severity Scale (in   Alameda Co. (Posted to       Each form is 3-pages of questions for caregivers of participating      http://icfhosting.com/hh/healthy
                         English and Spanish)        Exchange 12/12/2002)         asthmatic children. To be asked every two weeks for six months.        h.nsf/
Assessment                                                                                                                                                                                Y      X
                #03049   Asthma Severity Scale (in   Alameda Co. (Posted to       (Not sure how this differs from #47, except the layout is different)   http://icfhosting.com/hh/healthy
Assessment               English) #2                 Exchange 12/12/2002)                                                                                h.nsf/                           Y      X
                #03050   Daily Asthma Journal (in    Alameda Co. (Posted to       One-page form for recording asthma symptoms and resulting              http://icfhosting.com/hh/healthy
Assessment               English and Spanish)        Exchange 12/12/2002)         treatments.                                                            h.nsf/                           Y      X
                #03053   Knowledge Survey (in        Alameda Co. (Posted to       Each version is 2 pages. Asks yes/no and choose-best-answer            http://icfhosting.com/hh/healthy
Assessment               English and Spanish)        Exchange 12/12/2002)         questions about asthma triggers and home safety.                       h.nsf/                           Y      X
                #03055   Pre- and Post-Knowledge     Alameda Co. (Posted to       2-pages. Questionnaire for caregivers – intended to be verbally        http://icfhosting.com/hh/healthy
Assessment               Test                        Exchange 12/12/2002)         administered.                                                          h.nsf/                           Y      X
                #03056   Breath of Fresh Air - 2nd   Stamford.(Posted to          9 pages. Collects information on risks, current medications,           http://icfhosting.com/hh/healthy
                         Visit Assessment Test /     Exchange 12/31/2002)         asthma symptoms and treatment, and rates asthma severity and           h.nsf/
Assessment               Assessment protocols                                     adequacy of treatment.                                                                                  Y      X
                #03067   Asthma Knowledge Test – 2   Wisconsin (Posted to         2 pages of questions in Spanish.                                       http://icfhosting.com/hh/healthy
Assessment               (in Spanish)                Exchange 4/16/2002)                                                                                 h.nsf/                           Y      X
                #03068   IRB / Injury Consent Form   Wisconsin (Posted to   4-pages.                                                                     http://icfhosting.com/hh/healthy
Assessment               (in Spanish)                Exchange 4/16/2002)                                                                                 h.nsf/                           Y                       X                   X
                #03069   HOME Moisture Audit         NC State Univ/A&T Coop Several pages on website – includes forms (within web text)                  http://www.ces.ncsu.edu/copub
                                                     Extension                                                                                           s/house/care/005/

Assessment                                                                                                                                                                               N            X       X
                #03081   Visual Assessment and       Developed by Cleveland       Has long Visual Assessment and Testing form for the Cleveland          Cuyahoga County Grantee
                         Testing form                Dept. of Public Health and   Dept. of Public Health and EHW – says EHW last revised 3/23/99         Binder (hard copy available
                                                     EHW – last revised                                                                                  from ICF)
Assessment                                           3/23/99                                                                                                                             Y            X   X   X                       X
                #03082   Lead Safe Cuyahoga          Cuyahoga County HH           Includes almost 50 questions for the resident and a number ofCuyahoga County Grantee
                         Questionnaire               Grantee                      questions for the interviewer (assessment forms, for room    Binder (hard copy available
Assessment                                                                        sketches and home conditions, are also attached.             from ICF)                                 Y       X    X
                #03083   Instructions and Form for Cuyahoga County HH             (See #03081 – this form was revised by EHW in 3/6/2000)      Cuyahoga County Grantee
                         Visual Assessment and     Grantee                                                                                     Binder (hard copy available
Assessment               Testing                                                                                                               from ICF)                                 Y            X   X   X
                #03089   Remediation Scope Sheet   Bedford Stuyvesant HH    One-page form and instructions for assessing homes.                Bedford Stuyvesant Grantee
                                                   Grantee                                                                                     Binder (hard copy available
Assessment                                                                                                                                     from ICF)                                 Y            X       X
                #03091   Initial Visual Assessment Bedford Stuyvesant HH    Detailed form (about 25 pages) for use in the grantee‟s HHI        Bedford Stuyvesant Grantee
                         Protocol and              Grantee                  program.                                                           Binder (hard copy available
Assessment               Interview/Checklist                                                                                                   from ICF)                                 Y       X            X
                #03092   Healthy Homes Assessment Alameda County HH         Thirteen page report to residents containing the results of an     http://icfhosting.com/hh/healthy
                         Checklist                 Grantee (Posted 1/10/03) assessment of their home. The document contains information on h.nsf/
                                                                            environmental hazards in the home to place the home assessment
Assessment                                                                  in context.                                                                                                  Y            X   X            X              X
                #03093   Healthy Homes Report      Alameda County HH        Three page report to residents contains condensed results of an    http://icfhosting.com/hh/healthy
                         Tenant Summary            Grantee (Posted 1/10/03) assessment of their home. Contains tips on reducing                h.nsf/
Assessment                                                                  environmental hazards in the home.                                                                           Y            X   X            X              X
                #03094   Healthy Homes Visual      Alameda County HH        Seventeen page assessment for containing guidance for              http://icfhosting.com/hh/healthy
                         Assessment Form with      Grantee (Posted 1/10/03) inspectors.                                                        h.nsf/
Assessment               Instructions                                                                                                                                                    Y            X                          X
                #03095   Healthy Homes Visual      Alameda County HH        Twelve page report to residents containing the results of a visual http://icfhosting.com/hh/healthy
                         Assessment Report         Grantee (Posted 1/10/03) home inspection and recommendations for mitigating                 h.nsf/
Assessment                                                                  environmental hazards.                                                                                       Y            X                X




    Last updated: May 5, 2003                                                                                                                                Healthy Homes Toolbox                                                                                               Page 5
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                 #03096   Asthma Assessment Tools     Erie County (Posted to      Tools for assessing Asthma in residents                            http://icfhosting.com/hh/healthy
Assessment                                            Exchange 1/24/03)                                                                              h.nsf/                           Y             X                             X
                 #03097   Asthma Assessment Tool,     Erie County (Posted to      Tools for educating residents about mitigating environmental       http://icfhosting.com/hh/healthy
                          In-Home Education           Exchange 1/24/03)           hazards that cause and aggravate asthma.                           h.nsf/
Assessment                Management                                                                                                                                                  Y             X                             X
                 #03098   Post-Intervention Health    City of Long Beach          7-page questionnaire for public health nurses on resident's asthma http://icfhosting.com/hh/healthy
                          Interview (Public Health    (posted to the Exchange                                                                        h.nsf/
Assessment                Nurses)                     6/04/2003)                                                                                                                      Y
                 #03099   Demographic and Baseline    Erie County Health          6-page questionnaire on baseline information and quality of life.  http://icfhosting.com/hh/healthy
                          Information/QOL and         Department (posted to                                                                          h.nsf/
Assessment                Knowledge Pre-Post Test     Exchange 6/11/2003)                                                                                                             Y        X
                 #03100   Follow-Up Quality of Life   Erie County Health          1-page quality of life survey.                                     http://icfhosting.com/hh/healthy
                          Survey                      Department (posted to                                                                          h.nsf/
Assessment                                            Exchange 6/11/2003)                                                                                                             Y        X
                 #03101   Erie County Healthy Homes Erie County Health                                                                               http://icfhosting.com/hh/healthy
                          Initiative Asthma           Department (posted to                                                                          h.nsf/
                          Environmental Assessment Exchange 6/11/2003)
Assessment                Tool
                 #03102   Mount Sinai In-Person       Mount Sinai School of       3-page interview form for the first in-person interview. Mostly    http://icfhosting.com/hh/healthy
                          Interview                   Medicine grantee (posted    demographic information.                                           h.nsf/
                                                      to the Exchange
Assessment                                            6/17/2003)                                                                                                                        Y      X
                 #03103   Home Environment            Mount Sinai School of       2-page home environment assessment form.                           http://icfhosting.com/hh/healthy
                          Assessment                  Medicine grantee (posted                                                                       h.nsf/
                                                      to the Exchange
Assessment                                            6/17/2003)                                                                                                                        Y               X
                 #03104   Environment Assessment      Mount Sinai School of       4-page scoring guidance for the environment assessment.            http://icfhosting.com/hh/healthy
                          Scoring Guidance            Medicine grantee (posted                                                                       h.nsf/
                                                      to the Exchange
Assessment                                            6/17/2003)                                                                                                                        Y               X
                 #03105   Medications Compliance      Mount Sinai School of       3-page medications compliance form.                                http://icfhosting.com/hh/healthy
                          Form                        Medicine grantee (posted                                                                       h.nsf/
                                                      to the Exchange
Assessment                                            6/17/2003)                                                                                                                        Y      Y
                 #04003   Tobari Logic Model (Project HHI Website                 90-pages – available on-line.                                      http://www.hud.gov/offices/lead/
                          Planning and Evaluation                                                                                                    hhi/4L_GuidebookHUD_withLog
                          Guidebook: A Manual for                                                                                                    icModel.PDF
                          Practitioners and Managers
                          of Self-Sufficiency
                          Demonstration Projects)

Prgm Eval                                                                                                                                                                             N                                                X       X
                 #04041   Employee Assessment         Wisconsin (Posted to        One-page evaluation form for project employees.                    http://www.icfhosting.net/HUD/
                          Guide                       Exchange 4/16/2002)                                                                            HH/HealthyH.nsf/MasterDiscFr
Prgm Eval                                                                                                                                            ameset?OpenFrameSet              Y                                                X
                 #04066   Logic Model                 City of Long Beach          Logic model developed by Long Beach for evaluating their           http://icfhosting.com/hh/healthy
                                                      (Posted to Exchange         program.                                                           h.nsf/
Prgm Eval                                             4/9/2002)                                                                                                                       Y                                                X
                 #04067   Owner Interview             City of Long Beach          Owner Interview Questionnaire assessing changes in                 http://icfhosting.com/hh/healthy
                          Questionnaire               (Posted to Exchange         owner/manager's attitude/awareness after Healthy Homes             h.nsf/
Prgm Eval                                             5/19/2003)                  intervention.                                                                                       Y                                                        X
                 #05002   Risk Assessment Guide       HOME*A*Syst Program         “Home*A*Syst: An Environmental Risk-Assessment Guide for the       http://www.uwex.edu/homeasys
                                                      (University of Wisconsin)   Home is comprised of eleven chapters to help you learn about,      t/
                                                                                  investigate and take action on environmental health risks in and
Training &                                                                        around your home.
Outreach                                                                                                                                                                                N                                X        X




     Last updated: May 5, 2003                                                                                                                           Healthy Homes Toolbox                                                                                                    Page 6
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                 #05014   Help Yourself to a Healthy   HOME*A*Syst Program This resource from Home*A*Syst is a 24-page booklet that can               http://www.hud.gov/offices/lead/
                          Home: Protect Your           (University of Wisconsin) help you make sure your home is a safe and healthy place to be.      healthyhomes/healthyhomeboo
                          Children's Health            (also on HHI Website)     Find answers to questions like: Is the air in your home healthy? and k.pdf
                                                                                 Can your children be poisoned by lead in your home? (58-pages
                                                                                 when downloaded)
Training &
Outreach                                                                                                                                                                                 N                                X        X
                 #05015   Quick Tips                   CHEC Website               List of steps to protect families that is regularly updated.          http://www.checnet.org/healthe
                                                                                                                                                        house/education/tip.asp


Training &
Outreach                                                                                                                                                                                 Y                                X        X
                 #05017   How To                       CHEC Website               Series of guidelines to help residents deal with specific home        http://www.checnet.org/healthe
                                                                                  health issues, ranging from IAQ to drinking water to pest             house/education/top10.asp
                                                                                  management.


Training &
Outreach                                                                                                                                                                                 Y                                X        X
                 #05019   Chemicals                    CHEC Website            List of chemicals that may be harmful to children (includes scientific   http://www.checnet.org/healthe
Training &                                                                     and common names). Categorized as prevent, avoid, or limit               house/chemicals/chemicals.asp
Outreach                                                                       exposure.                                                                                                 Y                                X        X
                 #05020   A Brief Guide to Mold,       Mold Resources from the 20-page booklet from EPA on how to treat mold and why it is a            http://www.epa.gov/iaq/molds/i
                          Moisture, and Your Home      U.S. Environmental      hazard. Geared toward homeowners and renters.                            mages/moldguide.pdf
                                                       Protection Agency
Training &
Outreach                                                                                                                                                                                 N                                X        X
                 #05021   A Guide for Creating a       American Lung              20 page informational booklet ---“For tips on how to reduce indoor    http://www.lungusa.org/press/e
                          Healthier Home               Association                air pollution”                                                        nvir/download/creating_guidehh
Training &                                                                                                                                              .pdf
Outreach                                                                                                                                                                                 N                                X        X
                 #05022   Health House Rx Home         Health House (American     An interactive checklist, available online. Intended for homeowners http://www.healthhouse.org/iaq/
                          Checklist                    Lung Association)          to help them identify home environment problems and sources of      checklist.htm
                                                                                  pollution.




Training &
Outreach                                                                                                                                                                                 N                                X        X
Training &       #05039   Asthma Action Plan          Wisconsin (Posted to        One-page form for parents to help them act when child suffers an      http://icfhosting.com/hh/healthy
Outreach                                              Exchange 4/16/2002)         asthma attack                                                         h.nsf/                           Y                                X        X
Training &       #05052   How to Maintain A Healthy Alameda Co. (Posted to        2-pages. Addresses homeowners or tenants on home maintenance          http://icfhosting.com/hh/healthy
Outreach                  Home                        Exchange 12/12/2002)        and risk prevention in the home.                                      h.nsf/                           Y                                X        X
                 #05057   Asthma Powerpoint – “What City of Long Beach            About 18 powerpoint slides.                                           http://icfhosting.com/hh/healthy
Training &                is Asthma” (in English and (Posted to Exchange 4/9)                                                                           h.nsf/
Outreach                  Spanish)                                                                                                                                                       Y                                X        X
                 #05058   Healthy Homes Brochure      City of Long Beach          Flyer promoting the grantee‟s program (appears to be for              http://icfhosting.com/hh/healthy
Training &                                            (Posted to Exchange         recruiting).                                                          h.nsf/
Outreach                                              4/9/2002)                                                                                                                          Y                                X             X
                 #05059   Non-Toxic Cleaning Tips (in City of Long Beach          1-page flyer promoting the use of vinegar for household cleaning.     http://icfhosting.com/hh/healthy
Training &                English and Spanish)        (Posted to Exchange                                                                               h.nsf/
Outreach                                              4/9/2002)                                                                                                                          Y                                X        X




     Last updated: May 5, 2003                                                                                                                              Healthy Homes Toolbox                                                                                                  Page 7
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                 #05060   Unintentional Injures Info (in City of Long Beach       14 pages each – to inform residents about preventing injuries like   http://icfhosting.com/hh/healthy
Training &                English and Spanish)           (Posted to Exchange      burns, poisoning, fires, etc.                                        h.nsf/
Outreach                                                 4/9/2002)                                                                                                                        Y                                X        X
                 #05061   House Cleaning Tips (in        City of Long Beach       About 2 pages of cleaning methods that do not require chemicals.     http://icfhosting.com/hh/healthy
Training &                English and Spanish)           (Posted to Exchange                                                                           h.nsf/
Outreach                                                 4/9/2002)                                                                                                                        Y                                X        X
                 #05070   HealtheHouse                   CHEC Website             Online interactive quizzes that assesses structure/practices that    http://www.checnet.org/healthe
                                                                                  contribute to home health. (Full and mini quiz available)            house/profiler/
Training &
Outreach                                                                                                                                                                                  Y                                X        X
                 #05072   What Breeds Between the       CHEC Website              Website information and tips for residents on how to reduce          http://www.checnet.org/healthe
                          Walls: Allergens and                                    pollution in the home.                                               house/education/articles-
                          Asthma Triggers                                                                                                              detail.asp?Main_ID=384
Training &
Outreach                                                                                                                                                                                  Y                                X        X
                 #05073   How to Reduce Dust Mites      CHEC Website              List of 6 tips to reduce dust mites.                                 http://www.checnet.org/healthe
                          in Your Home                                                                                                                 house/education/top10-
                                                                                                                                                       detail.asp?Top10_Cat_ID=18
Training &
Outreach                                                                                                                                                                                  Y                                X        X
                 #05074   "The Inside Story: A Guide    EPA Web site (Frequently Booklet from EPA and Consumer Product Safety Commission to            http://www.epa.gov/iaq/pubs/ins
                          to Indoor Air Quality"        Asked Questions)         help residents decide whether to take actions that can reduce the     idest.html#order"
Training &                                                                       level of indoor air pollution in the home.
Outreach                                                                                                                                                                                  N                                X        X
Training &       #05085   Cockroach Control Guide       EHW HH Grantee            Short flyer (2 pages) on cockroaches                              EHW Grantee Binder (hard
Outreach                                                                                                                                            copy available from ICF)              Y                                X        X
Training &       #05086   Controlling Asthma Triggers   EHW HH Grantee            2-page flyer on home conditions that trigger asthma.              EHW Grantee Binder (hard
Outreach                  in the Home                                                                                                               copy available from ICF)              Y                                X        X
Training &       #05087   Flyer for the Rainbow                                   Flyer promoting the HHI program.                                  EHW Grantee Binder (hard
Outreach                  Asthma Study                                                                                                              copy available from ICF)              Y                                X             X
                 #05088   Flyer for the Bedford         Bedford Stuyvesant HH     Flyer promoting their HHI program.                                Bedford Stuyvesant Grantee
Training &                Stuyvesant Healthy Homes      Grantee                                                                                     Binder (hard copy available
Outreach                  Initiative                                                                                                                from ICF)                             Y                                X             X
                 #05090   Introductory letters to       Bedford Stuyvesant HH     Letters that inform both landlords and tenants about the program, Bedford Stuyvesant Grantee
Training &                owners and tenants            Grantee                   with promise to follow-up.                                        Binder (hard copy available
Outreach                                                                                                                                            from ICF)                             Y                       X        X
                 #05094   Bed-Stuy Training Curricula Bedford Stuyvesant HH       Stamped „draft‟. Comprehensive guide. Covers everything from      Bedford Stuyvesant Grantee
Training &                for Project Staff           Grantee                     asthma and medications to safe work conditions to cockroach and Binder (hard copy available
Outreach                                                                          rodent control                                                    from ICF)                             Y                                         X
                 #05095   Boston Healthy Homes          Boston Medical Center     About 25 pages. Cleaning instructions for residents with tips to  Boston Medical Center Grantee
Training &                Partnership Take Home         HH Grantee                reduce pests, toxins, and safety risks.                           Binder (hard copy available
Outreach                  Points                                                                                                                    from ICF)                             Y                                X        X
                 #05096   Community Health Educator     Boston Medical Center     Comprehensive Powerpoint training session (does not give timeline Boston Medical Center Grantee
Training &                Training                      HH Grantee                                                                                  Binder (hard copy available
Outreach                                                                                                                                            from ICF)                             Y                                         X
                 #05097   Role of Healthy Educator      Boston Medical Center     3-page instruction guide on the responsibilities of the health    Boston Medical Center Grantee
Training &                                              HH Grantee                educator in their HHI program.                                    Binder (hard copy available
Outreach                                                                                                                                            from ICF)                             Y                                         X    X
                 #05100   Protect Your Child from       Boston Medical Center     30 page handbook covering environmental risks, lead, indoor air   Boston Medical Center Grantee
                          Environmental Health          HH Grantee                pollution, first aid, and healthy habits.                         Binder (hard copy available
Training &                Hazards in the Home: A                                                                                                    from ICF)
Outreach                  Parent‟s Handbook                                                                                                                                          Y                                     X        X
                 #05101   Curriculum and                Boston Medical Center     Wide-ranging list of questions (almost 40 pages) on home             Boston Medical Center Grantee
Training &                Questionnaire                 HH Grantee                conditions, health violations, etc. Corresponding panel explains why Binder (hard copy available
Outreach                                                                          the questions are asked.                                             from ICF)                     Y           X                                  X




     Last updated: May 5, 2003                                                                                                                             Healthy Homes Toolbox                                                                                                    Page 8
                                                                                                                                                                                                                                          HUD Office of Healthy Homes and Lead Hazard Control




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                 #05102   How to Maintain a Healthy   Alameda County HH        Three-page summary of tips for residents on establishing a safe           http://icfhosting.com/hh/healthy
Training &                Home Form with Graphics     Grantee (Posted 1/10/03) home environment.                                                         h.nsf/
Outreach                                                                                                                                                                                    Y                                X        X
                 #05103   Healthy Homes Training      Alameda County HH        Seve-page training on asthma triggers, home maintenance, and              http://icfhosting.com/hh/healthy
Training &                Curriculum                  Grantee (Posted 3/10/03) lead hazard mitigation for residents.                                     h.nsf/
Outreach                                                                                                                                                                                  Y                     X                     X
Training &       #05104   Healthy Homes Brochure       Alameda County HH         Two pdf files containg the front and back of this marketing piece for   http://icfhosting.com/hh/healthy
Outreach                                               Grantee (Posted 4/7/03)   the Alameda County HH Grantee.                                          h.nsf/                           Y                                  X
                 #05105   The Privacy Rule of the      Wisconsin (Posted to      A 63-page training on the Privacy Rule of the Health Insurance          http://icfhosting.com/hh/healthy
                          Health Insurance Portability Exchange 4/11/2003)       Portability and Accountability Act, intended for clinicians.            h.nsf/
                          and Accountability Act:
Training &                Training for Clinicians
Outreach                                                                                                                                                                            Y                                                 X            X
Training &       #05106   HIPAA and Informed          Wisconsin (Posted to       Three page form documenting residents' permission for the release http://icfhosting.com/hh/healthy
Outreach                  Consent                     Exchange 4/11/2003)        of their children's health information to researchers.            h.nsf/                           Y                               X                      X       X
                 #05107   MOLD: Cause, Effect, and    U.S. Department of         Forty-three page informational booklet on mold.                   http://icfhosting.com/hh/healthy
                          Response                    Housing and Urban                                                                            h.nsf/
                                                      Development (Posted to
                                                      Exchange 4/11/03)
Training &
Outreach                                                                                                                                                                                    Y                                         X




     Last updated: May 5, 2003                                                                                                                               Healthy Homes Toolbox                                                                                                    Page 9

								
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