Choose Safe Places Property Questionnaire
The Choose Safe Places Program is a voluntary program for early care and preschool education providers to identify and address potential environmental concerns at or around child care facilities to protect children and staff from harmful substances in their environment.

We can help child care facilities be environmentally safe by helping identify safe locations for new child care. This is achieved by proactively identifying new and existing facilities that could be affected by hazardous chemicals, thereby reducing potential exposures.

If you have questions about completing this survey, contact us at 303-692-2606.
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Email *
Your information (Full name and phone number)
Property Address
Current Property Owner
Building Constructed:
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Have you tested for lead-based paint?
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Property was used as (check all that apply):
For any of the above checked boxes, please share any known information (Name of business, name of property owner, years of operation, additional information you think would be helpful):
Nearby businesses within eyesight (check all that apply):
What is your drinking water system type?
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If on non-public water system, has it been tested for contaminants?
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Has the water been tested for lead?
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Has the property been tested for radon?
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Does the property have a radon mitigation system?
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Other comments or questions you have:
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