Hazardous Materials Field Assessment Form
Perform a thorough on-site evaluation of hazardous materials conditions. Complete all sections for accurate assessment and documentation.
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessment Location
*
Type of Hazardous Material
*
Please Select
Chemical
Biological
Radiological
Unknown
Other
Observed Hazards
*
Spill/Leak
Vapors/Fumes
Fire/Explosion Risk
Corrosive Damage
None Observed
Other
Containment Status
*
Contained
Not Contained
Containment in Progress
Personal Protective Equipment (PPE) Used
Gloves
Respirator/Mask
Protective Suit
Eye Protection
Boots
Other
Risk Level Assessment
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Site Condition Evaluation
*
Rows
Poor
Fair
Good
Excellent
Material Storage
1
2
3
4
Ventilation
5
6
7
8
Access Control
9
10
11
12
Immediate Actions Taken
Secured Area
Contacted Specialist
Decontamination Started
Evacuation Initiated
No Action Needed
Other
Additional Notes or Recommendations
Submit Assessment
Should be Empty: