Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Weather Conditions During Site Reconaissance

  • Were any limiting conditions encountered during the site reconnaissance?

  • Identify Limiting Condition

  • Limiting Condition
  • Discussion/Comments

  • Limiting Condition Photos

General Description of Property

  • Add location
  • SITE ID (Tax Parcel No., GPIN, Other)

  • Adjacent Properties

  • North

  • Adjacent Property North Photos

  • Northeast

  • Adjacent Property Northeast Photos

  • East

  • Adjacent Property East Photos

  • Southeast

  • Adjacent Property Southeast Photos

  • South

  • Adjacent Property South Photos

  • Southwest

  • Adjacent Property Southwest Photos

  • West

  • Adjacent Property West Photos

  • Northwest

  • Adjacent Property Northwest Photos

  • Are there onsite structures?

  • Itemize Structures

  • Structure
  • Describe Structure

  • Photos of structures

  • Utilities & Waste Disposal

Hazardous Substances

  • Were Hazardous Substances Observed on site?

  • Substance Identity

  • substance
  • Identify Location Where Hazardous Substance Was Observed

  • Product Name

  • Containers

  • Observable Sign of Release?

  • Discussion

  • Hazardous Substance Photos

Petroleum Products (Not in Tanks)

  • Were Petroleum Products (Not in Tanks) Onserved on Site?

  • Product

  • Petroleum Product
  • Identify Location Where Petroleum Product Was Observed

  • Container

  • Observable Indication of Release?

  • Discussion/Comments

  • Photos (Petroleum Storage Not in Tanks)

Underground Storage Tanks

  • Known USTs on Site?

  • UST Identification

  • UST
  • Identify Location Where Known UST Was Observed

  • Contents

  • Construction

  • Capacity

  • Cathodic Protection

  • Leak Detection

  • Is There Reason to Suspect a Release?

  • Discussion / Comments

  • UST System Photos

  • Suspected USTs on Site?

  • Suspected UST
  • Identify Location Where Suspect UST Was Observed

  • Observed Condition

  • Is There Reason to Suspect Release?

  • Discussion/Comments

  • Suspect UST Photos

Aboveground Storage Tanks

  • Aboveground Storage Tanks on Site?

  • AST Identification

  • AST
  • Identify Location Where AST Was Observed

  • Contents

  • Capacity

  • Construction

  • Secondary Containment

  • Observed Indication of Release

  • Discussion/Comments

  • AST Photos

Suspect Containers

  • Suspect Containers on Site?

  • Suspect Container Identity

  • Suspect Container
  • Identify Location Where Suspect Container Was Observed

  • Container

  • Contents

  • Observed Indication of Release

  • Discussion/Comments

  • Suspect Container Photos

Equipment Likely to Contain PCBs

  • Are Utility Owned Transformers on Site?

  • Are Utility Owned Transformers Labeled NON-PCB?

  • Observed Indication of Release

  • Discussion/Comments

  • Photos - Utility Owned Transformers

  • Was Other Equipment Having Potential to Contain PCBs Observed?<br>(Note - fluorescent light ballasts excluded)

  • Suspect PCB Equipment

  • Suspected PCB
  • Identify Location Where Suspect PCB Equipment Was Observed

  • Identify Suspect PCB Equipment

  • Observed Indication of Release

  • Discussion/Comments

  • Suspect PCB Equipment Photos

Building Interior

  • Are There Buildings on Site?

  • Was Interior Staining or Corrosion Observed?

  • Identify Stain/Corrosion

  • Interior stain/corrosion
  • Identify Location Where Stain/Corrosion Was Observed

  • Discussion/Comments

  • Interior staining/corrosion photos

  • Were Sumps or Floor Drains Observed?

  • Identify Sump/Floor Drain

  • Sump/Floor Drain
  • Identify Location Where Sump/Floor Drain Was Observed

  • Discussion/Comments

  • Sump/Floor Drain Photos

  • Are Heating/Cooling Systems Present?

  • Describe System

  • Heating/Cooling System
  • Discussion/Comments

  • Heating/Cooling System Photos

Exterior Observations

  • Are there pits, ponds or lagoons on site?

  • Pit, Pond or Lagoon

  • Pit, Pond or lagoon
  • Identify Location Where Pit, Pond or Lagoon Was Observed

  • Describe

  • Pit, Pond Lagoon Photos

  • Are there storm water discharge structures on site?

  • Structure is

  • Structure
  • Identify Location Where Storm Water Structure Was Observed

  • Is there visible indication of disposal of petroleum or hazardous material in storm water structure?

  • Discussion/Comments

  • Storm water structure photos

  • Is there visible evidence of waste disposal on site?<br>EXCLUDING DUMPSTERS

  • Describe

  • Waste Disposal Area
  • Identify Location Where Waste Disposal Was Observed

  • Discussion/Comments

  • Waste disposal photos

  • Is there stained soil or pavement on site?

  • Describe

  • Stained Soil or Pavement Area
  • Identify Location Where Stained Soil or Pavement Was Observed

  • Describe source (if known) and size of stain

  • Stained Soil or Pavement Photos

  • Is there stressed vegetation on site?

  • Describe

  • Stressed Vegetation Area
  • Identify Location Where Stressed Vegetation Was Observed

  • Discussion/Comments

  • Stressed Vegetation Area Photos

  • Are there wells on site?

  • Well type

  • Well
  • Identify Location Where Well Was Observed

  • Discussion/Comments

  • Well Photos

  • Are there wastewater outfalls on site?

  • Identify Outfall

  • Outfall
  • Identify Location Where Outfall Was Observed

  • Discussion/Comments

  • Outfall Photos

  • Were odors observed during site reconnaissance?

  • Identify Location Where Odor Was Observed

  • Describe Odors

Notes

  • NOTES AND ANY ADDITIONAL COMMENTS/DISCUSSION (Including Interviews Conducted On Site)

Signature Page

  • Signature of Person Conducting Site Reconnaissance

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.