Corrosion Risk Assessment Questionnaire Form
Please complete the Corrosion Risk Assessment Questionnaire Form to help us evaluate and manage potential corrosion risks in your environment.
Site or Asset Name
*
Type of Environment
*
Industrial
Marine/Coastal
Urban
Rural
Other
Primary Material Exposed
*
Carbon Steel
Stainless Steel
Aluminum
Concrete
Other
Presence of Corrosive Agents (select all that apply)
*
Saltwater/Spray
Acids (e.g., sulfuric, hydrochloric)
Alkalis
Moisture/Humidity
Industrial Pollutants
None
Other
How often is maintenance performed?
*
Monthly or more frequent
Quarterly
Annually
Rarely/Never
Observed Corrosion (if any)
*
None
Minor Surface Rust
Pitting or Localized Corrosion
Generalized Corrosion
Please rate the effectiveness of current protective measures (e.g., coatings, inhibitors, cathodic protection)
*
1
2
3
4
5
Likelihood of Corrosion Occurrence (1 = Very Low, 5 = Very High)
*
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
Impact of Corrosion if it Occurs (1 = Negligible, 5 = Severe)
*
Negligible
1
2
3
4
Severe
5
1 is Negligible, 5 is Severe
Priority Areas for Corrosion Risk Mitigation (select up to 3)
Improved Maintenance
Upgraded Protective Coatings
Environmental Controls
Material Upgrades
Inspection/Monitoring
Other
Submit Assessment
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