Environmental Field Assessment Form

Environmental Field Assessment Form
Document and evaluate environmental conditions during field visits.
Assessor Name
First NameLast Name
Assessor Email Address
example@example.com
Date and Time of Assessment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Site Location Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
GPS Coordinates (if available)
Weather Conditions at Time of Assessment
Observed Environmental Factors
Rows Present Not Present Not Assessed
Water Pollution 1 2 3
Air Pollution 4 5 6
Soil Contamination 7 8 9
Litter/Waste 10 11 12
Vegetation Health 13 14 15
Wildlife Presence 16 17 18
Rate the overall environmental condition of the site

1
2
3
4
5
1 is Poor, 5 is Excellent
Upload Photos or Supporting Documents (optional)
Cancelof
Additional Observations or Comments
Recommendations or Required Actions
Should be Empty:

Rows	Present	Not Present	Not Assessed
Water Pollution	1	2	3
Air Pollution	4	5	6
Soil Contamination	7	8	9
Litter/Waste	10	11	12
Vegetation Health	13	14	15
Wildlife Presence	16	17	18

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