Groundwater Contamination Risk Assessment
Assessment Date
Assessor Name
Site Name
Location / Address
Coordinates (Latitude, Longitude)
Type of Site
Industrial
Agricultural
Residential
Landfill
Other
Current Land Use
Known Contaminants Present
Potential Sources of Contamination
Depth to Groundwater (meters)
Hydrogeology / Soil Type
Nearby Water Wells (Details)
Distance to Nearest Surface Water (meters)
Distance to Sensitive Receptors (schools, hospitals, etc.)
Observations / Field Notes
Initial Risk Rating
Low
Moderate
High