Please be advised that the use of airborne insulation and/or two-part foam may be hazardous to your health. Individuals with respiratory and breathing disorders should exercise extreme caution when the possibility of contact with insulation and/or two-part foam is imminent.
Because of the threat of possible illness resulting from the use of airborne insulation and/or two-part foam, the Agency requires that all occupants of the household with potential illnesses, vacate the premises during the insulation process.
The agency will install cellulose insulation that is blown and/or two-part foam under the following terms and conditions:
1. The premises must be vacated of individuals with potential illnesses that could be exacerbated or caused from the installation of insulation and/or two-part foam and must remain so for a reasonable time after installation.
2. The agency must be notified of anyone with respiratory/breathing problems or problems of past respiratory illnesses. (the agency may choose to use alternative insulating materials).
3. The agency will not assume responsibility or liability for any alleged injuries/illness resulting from the installation of insulation or two-part foam for failure of occupants to follow the warnings.
By signing this form, I acknowledge I have received a copy of the above warning and understand the nature of these warnings, and all members of the household agree to comply with the warnings.