Ground Risk Assessment

• Document No.

• Conducted on

  Date

• Client / Site

• Location
  Address

• Prepared by

Ground history

• 1) Has the ground been used for intensive livestock production (feedlots, stables, poultry houses)

  Yes

  No

  N/A

• 2) Has the ground been used as a landfill

  Yes

  No

  N/A

• 3) Has the ground been used as a chemical dump

  Yes

  No

  N/A

• 4) Has the ground been used for the production or storage of animal based agricultural products (compost, manure, blood/bone meal, etc.)

  Yes

  No

  N/A

• 5) Has the ground been used as livestock pasture (grazing animals)

  Yes

  No

  N/A

• 6) Has the ground been used for water treatment

  Yes

  No

  N/A

• 7) Has the ground been used for agriculture

  Yes

  No

  N/A

• 8) Is it virgin ground

  Yes

  No

  N/A

• 9) Has the ground been flooded. If so, specify date and details.

  Yes

  No

  N/A

Adjacent ground

• 10) Has been used or is being used for intensive livestock production (feedlots, stables, poultry houses)

  Yes

  No

  N/A

• 11) Has been used or is being used as a landfill

  Yes

  No

  N/A

• 12) Has been used or is being used as a chemical dump

  Yes

  No

  N/A

• 13) Has been used or is being used for the production or storage of animal based agricultural products (compost, manure, blood/bone meal, fish emulsions)

  Yes

  No

  N/A

• 14) Has been used or is being used as livestock pasture (grazing animals)

  Yes

  No

  N/A

• 15) Are there any water treatment plants

  Yes

  No

  N/A

• 16) Is there Housing/labor camps

  Yes

  No

  N/A

• 17) Is there evidence of a large population of wildlife

  Yes

  No

  N/A

• 18) Has it been used or is being used for agricultural use

  Yes

  No

  N/A

Water source

• 19) Water source

  Select Well City water Recycled water Reservoir Spring water River/Canal

  • Well
  • City water
  • Recycled water
  • Reservoir
  • Spring water
  • River/Canal

• 20) Irrigation method

  Select Drip irrigation Sprinkles/micro-sprinkles Furrow irrigation

  • Drip irrigation
  • Sprinkles/micro-sprinkles
  • Furrow irrigation

• 21) Are there any pesticides or fertilizers stored nearby

  Yes

  No

  N/A

• Select date

  Date

• 22) Are there any animal based agricultural products nearby

  Yes

  No

  N/A

• 23) Do domestic animals or wildlife have access

  Yes

  No

  N/A

• 24) Is there a microbiological analysis available

  Yes

  No

  N/A

Risk mitigation measures

Mitigation measure

Is the grown accepted?

• YES

• NO