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Five-Year Review Summary Form

The Five-Year Review Summary Form is intended to provide general five-year review site information, a summary of issues and recommendations, and a summary of all required protectiveness determinations. The modified Five-Year Review Summary Form provides a tabular format for issues, recommendations and protectiveness statements that are consistent with five-year review CERCLIS data entry requirements to facilitate accurate data entry.

A link to the Five-Year Review Summary Form is provided below. For ease of use, the summary form is embedded in an editable Microsoft Word document. The intent is to allow the user to incorporate the Five-Year Review report around the Five-Year Review Summary Form template.

Instructions for Completing the Five-Year Review Summary Form:

  1. Click on the link below to access the Five-Year Summary Form template.
  2. For information entry into the Summary Form:
    1. Data entry fields that state "Click here the enter text" require the user to enter the appropriate information.
    2. Data entry fields that state "Click here to enter date" require the user to type in the appropriate date.
    3. Data entry fields that state "Choose an item" require the user to select an option from a drop down menu.
  3. To add additional issue/recommendations, copy and paste the table under the Issues/Recommendations heading on page 2.
  4. To add additional protectiveness determinations and statements, copy and paste the table under the Protectiveness Statement(s) heading on page 2.

FYR Summary Form (MS Word)

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