Property History Questionnaire for Child Care Centers

The Texas Department of State Health Services (DSHS) Safe Child Care Siting Initiative is working to help licensed child care centers, school-age programs, and before and after school programs (hereinafter referred to as child care centers) keep children and staff safe from exposure to dangerous chemicals. Past manufacturing, industrial, or agricultural uses can sometimes leave hazardous chemicals behind in buildings or on the land. In addition, if businesses using chemicals (such as dry cleaners, nail salons, or auto body shops) are within the same building complex as a child care center, the indoor environment of the facility may be impacted by the chemicals.

Through its Safe Child Care Siting Initiative, DSHS will provide technical assistance to new and existing child care centers, assisting them in choosing locations for their centers that are safe from environmental contamination. This initiative is part of a national effort to protect children from exposure to harmful chemicals where they learn and play.

This is a voluntary questionnaire. Your answers will help the Texas Department of State Health Services (DSHS) provide you with technical assistance. Please answer the following questions on the next page to the best of your ability, going back in time as far as possible.

You may want to reach out to the following entities to help you complete these questions:

· Local Health Department (LHD) http://www.dshs.texas.gov/regions/lhds.shtm  
· Town or county clerk’s office
· Town tax assessor
· Property Owner
· Planning and Zoning Office
· Development Services Department

If you have questions, please contact the DSHS Health Assessment and Toxicology Program at 1-800-588-1248 or epitox@dshs.texas.gov.

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