Environmental Impact Risk Mitigation Assessment Form
Use this form to assess environmental impact risks, document existing controls, and plan mitigation and monitoring actions for a project, site, or activity.
Project / Site Overview
Project or Site Name
*
Organization or Department Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location / Area Description
*
Project / Activity Description
*
Environmental Risk Assessment
Environmental Aspects / Impact Areas Assessment
*
Rows
Impact Severity
Likelihood of Occurrence
Current Control Effectiveness
Air
1
2
3
Water
4
5
6
Soil
7
8
9
Noise
10
11
12
Biodiversity
13
14
15
Waste
16
17
18
Energy
19
20
21
Community
22
23
24
Overall Environmental Risk Level
*
Low
Moderate
High
Critical
Priority for Mitigation Action
*
1
2
3
4
5
Likelihood of Significant Impact
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
Mitigation and Monitoring Plan
Existing Mitigation Measures
Proposed Additional Mitigation Actions
Monitoring Indicators / Metrics
Monitoring Frequency
*
Daily
Weekly
Monthly
Quarterly
Biannually
Annually
As Needed
Other
Implementation Timeline / Target Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Responsible Person / Role
*
Follow-up Review Comments / Notes
Submit Assessment
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