Amchitka Island, Alaska, is a historical underground nuclear test site. Three underground tests were conducted there by the United States Atomic Energy Commission, now US Department of Energy (USDOE), between 1965 and 1971. These were Long Shot, an 80 kiloton detonation; Milrow, a 1 megaton detonation; and Cannikin, a 5 megaton detonation. Subsequent to these tests, several scientific assessments have been conducted regarding the impacts of the tests on the terrestrial and marine environments surrounding the island. However, many citizens and groups still voice concerns over the potential for detrimental effects on human and ecological health. In its responsibility for the long term protection of human and ecological health consequent to its nuclear programme, USDOE has recently prepared a plan for the long term surveillance and monitoring of the site. The purpose of this paper is to summarise the history of the island, specifically with regards to its use as a nuclear test site, to summarise the results of investigative activities following testing, to summarise USDOE's plan for surveillance and monitoring, and to offer the authors' viewpoints on the long term stewardship of the island. The authors deemed the stewardship plan to be essentially protective of human and ecological health; however, they recommend a stronger commitment to site oversight and review, as well as to future research, for addressing uncertainties remaining at the island.