Environmental Management Systems Forms

Action Plan
Emergency Plan
Process Identification Plan
Environmental Policy

Prevention Plan
Training Plan
Material Identification Plan

Action Plan Form (Sample)

Category:     Water waste
Subject:        Water reuse

Specific objectives and targets

Objective:Minimize water use however technically and commercially practical.

Target:Reduce water consumption at selected sites by 15percent of present levels within one year.

Action team and team leader




Team Leader


Team Member


Team Leader


Project stages in the life cycle of the company's products, service and activities 

Low Impact = L  Medium Impact = M  High Impact = H Classification table for degree of impact & period of occurrence:




Production/ Distribution

Auxiliary Services

Use/ Service

Waste Management









Severity of impact

Probability of occurrence

Potential legal exposure

Cost of changing the impact

Effect on the public image

Cost- effective benefits









Measures to eliminate or minimize the negative environmental impact

  • Measure to reduce water consumption and monitor its use:
  • Purchase hose guns, water meters and timer valves. Repair all leaks.
  • Purchase equipment to allow recycling rinsing water from process A to process B.

Required information and resources; action team assistants

Who is responsible for searching information?

  • Environmental Task Group - Mr. Joe Water - Project Coordinator

Types of information:

  • Consult engineering department for advice on equipment.
  • Purchase department will search for water recycle equipment (model, specification, and price) and make arrangements for installation.
  • Operation manager will arrange training and start-up requirements.

Other sources of information:

  • The Internet (a good searching tool)
  • Water-related environmental agency or organization

Schedule of activities, dates and deadlines

  • Repair all leaks - 10 days - by 20/09/2001
  • Purchase of hose guns, water meters, and timer valves - 10 days - by 20/09/2001
  • Installation of hose guns, water meters, and timer valves - 20 days - by 10/10/2001
  • Purchase of equipment to recycle water - 30 days - 30/09/2001
  • Installation of equipment - 60 days - 30/10/2001 (forecast)

Performance measurements

  • Water consumption is already measured monthly.
  • Ms. A (accounting department) will provide data to Mr. B (environmental task group) every month.
  • Mr. C (operating department) will record gallons of water recycled during rising process and inform Mr. B (environmental task group) every month.

List of expected benefits

  • Reduction of 35 percent of water consumption cost. Saving of $currency_symbol$xxxx.
  • New equipment increased production by eight percent.
  • Environmental friendly action - information for next marketing campaign.
  • Payback period between two months and three years.

Investment costs

  • Provision:
  • Equipment  $currency_symbol$xxxxxx
  • Management 17 hours .
  • Level B staff  28 hours.

Date for first assessment

The water consumption is monitored monthly. The results of the first six months should be compared and reviews by the environmental task group, presented to the top management and communicated to staff.

Prevention Plan Form (sample)


Requested  Date


Date for the first review to be expected





Requested by


Issued by


Issued to


Problem Statement


Most Likely Causes


Implemented Solutions (include dates as applicable)


Results (confirming effectiveness)


Emergency Plan Form (sample)


Issue (Potential emergency situations - fires, explosions hazardous materials spills, etc.)


Problem Statement


Emergency Response Procedures (include communication procedures)


Locations and Types of Emergency Response Equipment


Evacuation Routes and Exits (map)


Training Plan Form (sample)


Training Topic





EMS Awareness


Chemical Management


Spill Prevention and Response


Emergency Response


Hazardous Waste Management


Process Identification Form (sample)


Comments, Suggestions and Recommendations for Improvements



Storage On Site


Product Design


Raw Material (Substitutes / Reductions)


Waste Disposal


Water Use/Discharge


Energy Sources/Use


Solid and Hazardous Waste




Evaporation losses


Maintenance losses




Corrosive waste


Reactive waste


Toxic waste


Spoiled batches




Transport and Distribution




Material Identification Form (sample)




Material Used


Product Name


Chemical Name


Amount Used
Amount (gallons, lbs. or drums) used per (day, month or year)


Environmental Policy (sample)

An environmental policy is a unique document for each organization. The following example is intended to illustrate and provide ideas for writing an environmental policy that suits the company's commitment to environmental issues.

Company X's Environmental Policy

Company X is committed to a clean, healthy environment. "We will provide our customers with safe, reliable and responsive utility service in an environmentally sensitive and responsible manner. We believe that sound environmental policy contributes to our competitive strength and benefits our customers, shareholders, and employees by contributing to the overall well-being and economic health of the communities we serve."

We will:

  • Comply fully with the letter and spirit of environmental laws and regulations, and strive to secure fundamental reforms that will improve their environmental effectiveness and reduce the cost of compliance.
  • Consider environmental factors and the full acquisition, use and disposal costs when making planning, purchasing and operating decisions.
  • Provide appropriate environmental training for all staff.
  • Monitor our environmental performance regularly through rigorous evaluations.
  • Reuse and recycle whenever possible.
  • Use environmentally preferred materials.
  • Work cooperatively with others to further common environmental objectives.

Statement of Corporate Environmental Policy

Company X is committed to the continual improvement of its Environmental Management System (EMS), which includes waste minimization, pollution prevention and compliance with all relevant federal, state, and local environmental legislation and regulations. The company will meet or exceed the environmental requirements of other organizations to which Company X subscribes.  To sustain this commitment, the requirements of the Environmental Management System described in our EMS Action Plan apply to all activities, equipment, material and employees.

The company's Environmental Task Group is the company's EMS Management Representative, with the responsibility and authority to plan, enforce, and maintain the company's Environmental Management System. The Environmental Task Group, with the assistance of the Environmental Action Group and Audit Team, will propose annual targets and objectives to be approved by the Management Review Board.

The EMS Environmental Task Group may delegate some of this authority downward through the organization in order to effectively implement the system.



President and CEO(date)