Environmental Questionnaire Sample & Example

An environmental questionnaire is a preliminary task in the environmental due diligence process by lenders and other information-seekers. The questionnaire screens the environmental hazards of a property undergoing any transaction. It consolidates the known facts of a property upfront, for a basic level of contamination and health risk presumption. Typically, the environmental questionnaire example takes place in the pre-loan qualification process. And in the same way, the form applies to sales and title transfers. Ultimately, any possibility of contamination could lead to the ordering of a transaction screen assessment, desktop report, or Phase 1 Environmental report. Updated April 9, 2024.

Publicly Available Environmental Questionnaire Sample

Geo Forward provides a free Environmental Questionnaire sample for all parties to benefit from. The document is available for download directly from the Geo Forward website and is in the form of a PDF. Consumers are free to download copies of this questionnaire and use it for personal or commercial use, as per the terms and conditions on the document itself.

Environmental Questionnaire Example

At the very least, a typical form requests information about the historical and current occupants of the property, the land use, utility service providers, and whether any prior reports or concerns took place. In the spirit of training and sharing information, Geo Forward provides a free Environmental Questionnaire Example online. The complete form is available in PDF format via the Geo Forward website. Additionally, the images below demonstrate the comprising inquiries and information.

Environmental Questionnaire vs Phase 1 ESA

The environmental questionnaire form is only a basic screening tool in a loan process. This is a preliminary step for risk assessment and isn’t a comprehensive ESA report. Unlike a Phase 1 ESA, the questionnaire does not require completion by an environmental professional. It is merely a tool for lenders or other entities to use before obtaining an ESA report. However, a Phase 1 Environmental Site Assessment is a comprehensive report and requires the certification and oversight of an environmental professional. Consequently, this form does not replace a proper Phase 1 ESA.

Purpose of the Form

If an environmental questionnaire indicates any chance of environmental risk, the services of an environmental professional then become a requirement. This might begin with a transaction screen review or an environmental desktop report. In the same way, the requirement for a proper Phase 1 ESA report may become necessary.

Cover All Grounds During an ESA Report

On the other hand, this form can also be requested by an environmental professional, during a transaction screen review, desktop report, or Phase 1 ESA. For instance, a geologist can utilize the written statement of the current tenant or property owner, by asking them to document their official land use in the questionnaire. Similarly, an engineering consultant may request their Client or the report user to complete the form as well. The objective in the case is to cover all grounds during a comprehensive assessment.

Small Business Administration – SBA Environmental Review Process

The Small Business Administration (SBA) specifies its own requirements for an environmental questionnaire. For instance, the SBA environmental questionnaire can request information about an adjacent property, as well as the Subject Site itself. For instance, a multi-family lot that is adjacent to a gasoline service station may have a contamination migration concern. Thus, further investigation may be in order. The SBA suggests lenders complete this form in good faith, upon visiting a property. Similarly, consultants also request users of an SBA Phase 1 ESA, to complete the form as well.

USDA Requirements

Similarly, the USDA states any activity that may adversely affect the environment must not be undertaken without completing a “Rural Development Environmental Report.” Thus, in the same way as the SBA, the USDA implements additional pre-screening requirements. Moreover, other entities and institutions are also requiring a preliminary due diligence process, on the basis of an environmental questionnaire.

Signing the Form?

Most environmental questionnaire forms do not require a signature or certification. However, it is not uncommon for consultants or institutions to include their own signature requirements on the questionnaire. The objective is to maintain an authentication factor, and hold those completing the form accountable for their answers. Nonetheless, all questionnaires (regardless of purpose or origin) are required to be performed in good faith.

Digital Execution

With the use of modern technologies, it is now easier than ever to authorize and certify the questionnaire. In fact, Geo Forward offers a professional service that assists users in the form completion process. And upon completion, users are able to review their answers and certify their approval in the form of a digital signature. The process is fast, easy, and secure.

User Data Request Form

A User Data Request Form, or a “User Data Questionnaire,” is a little different from an environmental questionnaire. The two forms should not to be confused with one another. However, there may be some overlapping information. To illustrate, a Phase 1 ESA report user must provide a User Data Request Form to the environmental professional, in order to qualify for Landowner Liability Protection. This is a part of the Brownfields Revitalization Act.

Cleanup Liens & Activity or Land Uses Limitations

There are at least four pillars to the standard User Data Request Form. The first inquiry involves the potential knowledge of environmental cleanup liens against the site. The second question pertains to any knowledge of activity or land-use limitations currently on-site, or whether any have been recorded before. The third inquiry involves the specialized knowledge or experience of the person potentially seeking to qualify for the Landowner Liability Protection. And lastly, the fourth question clarifies the relationship of the purchase price to the fair market value of the property, if there is no contamination. Failure to provide the User Data Request Form information could result in a determination that the “all appropriate inquiry” requirement is incomplete.

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