CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER p: HAZARDOUS AND POISONOUS SUBSTANCES
PART 845 LEAD POISONING PREVENTION CODE
SECTION 845.APPENDIX F CHILDHOOD LEAD RISK ASSESSMENT QUESTIONNAIRE
Section 845.APPENDIX F Childhood Lead Risk Assessment Questionnaire
ILLINOIS DEPARTMENT OF PUBLIC HEALTH DIVISION OF FAMILY HEALTH CHILDHOOD LEAD RISK ASSESSMENT QUESTIONNAIRE
Medical evaluation of a patient to determine lead exposure includes knowledge of the child's geographic location and living conditions in combination with the history and physical exam. The first question in this process is:
DOES THE CHILD, AGES 6 MONTHS TO 24 MONTHS, LIVE IN A HIGH RISK ZIP CODE AREA (REFER TO ZIP CODES ON REVERSE SIDE)?
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(If "N" continue with additional questions) |
Y |
N |
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ASSESSMENT OF ALL OTHER CHILDREN |
Circle the appropriate response |
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Does the child, ages 6 months to 24 months: |
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Live in or regularly visit a home or building (school or daycare) built before 1960? |
Y |
N |
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Live in or regularly visit a home or building built before 1960 which has recently been or is currently under renovation or remodeling? |
Y |
N |
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Live with a person whose occupation or hobby involves exposure to lead? |
Y |
N |
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Receive or have ever received herbal medicines or home remedies (see guidelines)? |
Y |
N |
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POPULATION BASED ASSESSMENT QUESTIONS |
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(Use at physician's discretion) |
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Live close to an active lead smelter, battery recycling plant, lead mine, and/or other industry likely to release lead into the environment? |
Y |
N |
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Does the family use imported or glazed ceramics for food preparation, storage or as dinnerware? |
Y |
N |
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Ever been to Central or South America or Mexico where lead exposure could potentially occur? |
Y |
N |
CHILDREN WITH A POSITIVE RESPONSE TO ANY ONE OF THE QUESTIONS NOTED ABOVE WILL NEED BLOOD LEAD TESTING TO COMPLETE THE SCREENING PROCESS. DUE TO SIMILAR ENVIRONMENTAL EXPOSURE, CHILDREN WITH SIBLINGS WHO HAVE ELEVATED BLOOD LEAD LEVELS SHOULD HAVE BLOOD LEAD TESTING.
The Lead Risk Assessment Tool may be used to complete the Lead Assessment component of the Well Child visit. The assessment is recommended annually for all children from 6 months through 24 months of age.
POSSIBLE METHODS OF EXPOSURE
OCCUPATIONS
Auto repair
Battery manufacture or repair
Brass/copper foundry
Bridge reconstruction workers
Chemical/chemical preparation manufacturers
Construction workers
Gas station attendants
Glass manufacturers
Industrial machinery equipment operators
Lead smelters and refiners
Lead miner
Plastics manufacturers
Plumbers, pipe fitters
Police officers
Printers
Radiator repair
Rubber products manufacturers
Steel welders and cutters
EVNIRONMENTAL
Ceramics/Pottery
Lead crystal
Lead paint
Lead painted homes
Lead soldered cans (imported)
Proximity to lead related industries
Renovating/remodeling older homes
Soil/dust near industries, roadways
Use of water from leaded pipes
HOBBIES
Car or boat repair
Casting lead figures (toy soldiers, etc.)
Furniture refinishing
Home remodeling
Jewelry making
Lead soldering (i.e., electronics)
Painting
Preparing lead shot, fishing sinkers, bullets
Reloading cartridges
Stained glass making
Target shooting at firing ranges
OTHER
Asian Cosmetics
Folk remedies (greta, azarcon, pay-loo-ah, ghasard, Hai ge fen, Bali Goli, Kandu, Kohl, X-yoo-Fa, Mai ge fen and poying ton)
Imported food in lead soldered cans
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HIGH RISK ZIP CODE |
Blood test mandatory. Repeat as noted in Guidelines. |
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Risk Assessment Questionnaire |
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LOW RISK ZIP CODES |
Blood lead test required for any yes answer. Follow-up as indicated in Guidelines. |
No blood lead test required when all answers are no. Reassess annually at each Well Child visit. |
Pediatric Lean Poisoning High Risk ZIP Code Areas
Adams
62301
62312
62324
62325
62338
62339
62343
62346
62348
62351
62359
62365
Alexander
62913
62914
62961
62962
62993
Bond
62086
62246
62262
Boone
None
Brown
62324
62353
62375
62378
Bureau
61314
61322
61323
61328
61329
61337
61338
61342
61344
61345
61346
61349
61361
61362
61368
61374
61376
61421
Calhoun
62006
62013
62036
62045
62047
62053
62065
62070
62355
62361
Carroll
61014
61046
61051
61053
61064
61074
61285
Cass
62617
62618
Champaign
61810
61816
61820
61845
61849
61851
61862
61868
61956
Christian
62075
62510
62531
62540
62546
62550
62557
62568
Clark
62420
62442
62477
Clay
62426
62824
62839
62847
62858
Clinton
62471
62801
Coles
61938
Cook
All Chicago
ZIP Codes
60022
60093
60153
60201
60202
60305
60402
60406
60411
60426
60472
60501
60513
60546
60666
Crawford
62427
62433
62449
62451
62454
62464
62466
Cumberland
62420
62428
62432
62435
62468
DeWitt
61727
DeKalb
60550
60556
61353
Douglas
61911
61913
61930
61941
61942
61956
DuPage
None
Edgar
61917
61924
61932
61933
61940
61944
61949
Edwards
62476
62806
62818
62844
62863
Effingham
62414
62426
Fayette
62262
62414
62418
62458
62471
62838
62857
62880
62885
Ford
60919
60933
60946
60952
60957
60959
60960
60962
61773
Franklin
62805
62812
62822
62874
62884
62896
62983
62999
Fulton
61415
61427
61431
61432
61441
61459
61477
61484
61501
61520
61524
61531
61542
61543
61544
61563
Gallatin
62867
62869
62954
62979
Greene
62016
62027
62031
62044
62050
62078
62081
62082
62092
Grundy
60474
Hamilton
62817
62828
62859
62860
62887
Hancock
62311
62316
62318
62321
62330
62334
62348
62367
62380
Hardin
62919
62931
62955
62982
Henderson
61418
61454
61460
61469
61471
61476
62330
Henry
61234
61235
61238
61258
61274
61277
61413
61434
61443
61490
Iroquois
60912
60918
60924
60931
60938
60942
60945
60951
60953
60955
60956
60960
60964
60966
60967
60968
60970
Jackson
62927
62942
62950
62994
61064
Jasper
62432
62448
62459
62475
62480
Jefferson
62810
62846
62851
62864
Jersey
62031
62052
62063
Jo Daviess
61053
61074
61085
61087
Johnson
62908
62909
62912
62923
62967
62972
Kane
60505
Kankakee
60901
60912
60913
60915
60919
60944
60954
60964
Kendall
None
Knox
61401
61415
61434
61436
61458
61467
61474
61485
61489
61572
Lake
60040
60064
60085
LaSalle
60470
60518
61301
61321
61325
61341
61342
61348
61350
61354
61358
61364
61370
61371
61377
Lawrence
62415
62417
62439
62460
62466
Lee
61006
61021
61031
61042
61057
61353
Livingston
60921
60929
60934
61319
61333
61364
61740
61741
Logan
62541
62543
62548
62635
62643
62666
62671
Macon
62501
62521
62522
62523
62537
62544
62551
Macoupin
62002
62009
62033
62056
62063
62069
62079
62085
62088
62093
62649
62672
62674
62676
62683
62685
Madison
62002
62018
62024
62040
62048
62060
62074
62084
62087
62090
62095
Marion
62801
62849
62882
Marshall
61358
61369
61377
61421
61424
61537
61540
61541
61570
Mason
61567
62617
62633
62644
62664
62682
Massac
62910
62953
62960
McDonough
61416
61420
61422
61438
61471
61475
62326
62367
McHenry
None
62370
McLean
61701
61720
61724
61728
61730
61731
61737
61770
Menard
62664
62673
Mercer
61231
61260
61412
61442
61465
61466
61476
Monroe
62295
62425
Montgomery
62032
62049
62051
62056
62075
62076
62089
62094
Morgan
62082
62631
62694
Moultrie
61911
61925
61928
61937
61951
62264
Ogle
61006
61021
61030
61031
61039
61054
61061
61064
61102
Peoria
61529
61569
61602
61603
61604
61605
61606
Perry
62237
62831
62884
62888
62694
Piatt
61813
61830
61913
Pike
62312
62314
62323
62332
62340
62343
62345
62352
62355
62356
62357
62361
62362
62363
62366
62372
Pope
62938
62944
Pulaski
62926
62941
62956
62963
62964
62970
62973
Putnam
61340
Randolph
62237
62242
62272
62277
Richland
62450
62868
Rock Island
61201
61239
61265
61282
St. Clair
62040
62201
62203
62204
62205
62206
62207
62220
62225
62240
62257
62289
Saline
62917
62930
62935
62946
Sangamon
62539
62702
62703
Schuyler
61452
62319
62344
62367
62624
Scott
62050
62082
62610
62621
Shelby
61928
61951
61957
62414
62431
62444
62465
62510
62550
62553
62565
Stark
61421
61449
61479
61483
61491
Stephenson
61013
61032
61039
61050
61089
Tazewell
61554
61564
61734
Union
62926
62961
62998
Vermilion
60932
60942
60960
60963
61810
61812
61831
61832
61833
61844
61846
61857
61865
61876
61883
Wabash
62863
Warren
61412
61415
61417
61447
61453
61462
61478
Washington
62271
62801
62808
62831
Wayne
62823
62824
62837
62842
62843
62851
62878
62886
62895
White
62817
62820
62821
62827
62834
62835
62844
62861
62862
62867
62869
62887
Whiteside
61014
61071
61081
61243
61252
61261
61270
61277
61283
Will
60432
60433
Williamson
62921
62948
62949
62951
Winnebago
61077
61101
61102
61103
61104
Woodford
61545
61561
61570
61738
61760
(Source: Amended at 24 Ill. Reg. 11974, effective August 1, 2000)