Environmental Drilling Assessment Checklist Form
Use this form to complete a clear environmental drilling site assessment checklist, record drilling conditions, note compliance items, and capture any follow-up actions.
Site and Drill Identification
Site/Project Name
*
Site Location / Drilling Area
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Drilling Crew / Company Name
*
Assessor Name or Role
Environmental Drilling Checklist
Drilling Conditions and Controls Assessment
*
Rows
Compliant
Needs Attention
Not Observed
Site containment in place
1
2
3
Spill prevention materials available
4
5
6
Borehole protection maintained
7
8
9
Surface water protection implemented
10
11
12
Dust control measures in use
13
14
15
Waste handling is appropriate
16
17
18
Equipment condition is acceptable
19
20
21
Site housekeeping is satisfactory
22
23
24
Applicable Control Measures Observed
Site containment
Spill prevention materials
Borehole protection
Surface water protection
Dust control
Waste handling
Equipment condition
Site housekeeping
Item Notes and Exceptions
Final Comments / Exceptions
Overall Assessment Outcome
Overall Status
*
Pass
Pass with Notes
Fail
Corrective Action Priority
Please Select
Low
Medium
High
Urgent
Corrective Action / Follow-up Notes
Submit Form
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