Water Utility Risk Assessment Form
Assess risks, identify major concerns, and record mitigation actions for a water utility site or asset.
Asset and Location Details
Facility or Site Name
*
Asset or System Type
*
Treatment Plant
Pump Station
Reservoir
Distribution Main
Storage Tank
Other
Location or Service Area
*
Risk Assessment Inputs
Assessment Date
*
-
Month
-
Day
Year
Date
Overall Risk Level
*
1
2
3
4
5
Likelihood of Incident
*
1
2
3
4
5
Impact Severity
*
1
2
3
4
5
Primary Risk Categories Observed
*
Water Quality
Aging Infrastructure
Leaks/Breaks
Power Outage
Flooding
Contamination
Equipment Failure
Cybersecurity
Staffing
Other
Mitigation and Follow-Up
Immediate Mitigation Actions Needed
*
Person Responsible for Follow-Up
*
Submit Assessment
Should be Empty: