Submit New Application

TEST SITE Application

Please complete this application to become an approved Ohio Lead Test Site.

In the Affidavit at the end of this document, you will attest that you have read, understood, and will abide by the following Test Site Agreement document. Please print the document and keep it for your records.

Click to Open: Test Site Agreement

Your application is not complete until the required information is included, then select “Send Application.”

Name

Fax

Phone

Alt Phone

Administrator

Address

City

State

Zipcode

Mailing Address

Address

City

State

Zipcode

Candidate Directions

Additional Directions: Candidates receive a confirmation letter with the address of your facility upon scheduling. If you have any additional directions for how to get there or where to go once they arrive, please provide that information here. (For example, landmarks to look for, parking lot to use, building number, entrance number, floor and room number, or any other directions that help candidates get to your test site.

Affidavit

TEST SITE AGREEMENT:

I hereby agree to and understand that our Facility will allow Ohio LEAD tests to be administered under the guidelines in the Test Site Agreement.
I certify that our site is not under authoritative sanctions, and I have read, understood, and will abide by all listed guidelines in the Test Site Agreement.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.

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