Industrial Water Risk Assessment Form
Evaluate and document water-related risks at your industrial facility.
Facility Name
*
Facility Location (City, State, or Region)
*
Primary Water Source
*
Municipal Supply
Groundwater (Well)
Surface Water (River/Lake)
Recycled/Reuse Water
Other
Main Process Areas Using Water
*
Cooling
Boiler/Steam Generation
Cleaning/Sanitation
Product Ingredient
Other
Rate the following water-related risk factors for this facility
*
Rows
Low
Medium
High
Water Supply Interruption
1
2
3
Water Quality Deviation
4
5
6
Equipment Corrosion/Scaling
7
8
9
Regulatory Compliance
10
11
12
Discharge/Environmental Impact
13
14
15
How effective are current controls in managing water-related risks?
*
1
2
3
4
5
Have there been any water-related incidents in the past 3 years?
*
No incidents
Yes, minor incidents
Yes, major incidents
If yes, briefly describe the incident(s) and corrective actions taken
Overall water risk level for this facility
*
Low
Moderate
High
Additional Comments or Recommendations
Submit Assessment
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