Groundwater environmental risk early warning is essential for sustainable groundwater use and ecological security. However, a comprehensive system that considers both groundwater and ecological factors is yet to be established, thus severely hindering the accurate identification of groundwater environmental risks. To bridge this knowledge gap, this study developed a groundwater environmental risk early warning model (PQLRT) by incorporating five aspects: groundwater pollution risk (P), groundwater quality trends (Q), groundwater level trends (L), ecological risk (R), and ecosystem evolution trends (T). The western Songnen Plain was selected as a typical area to apply the model under current conditions. The PQLRT model effectively captured regional groundwater risk characteristics and achieved multi-dimensional groundwater environmental risk early warning. The results indicate that the groundwater pollution risk was primarily influenced by pollution source loads from paddy and dryland fields, which generally exhibited moderate pollution risks. Ecological risk, primarily influenced by population density, was generally low. Approximately 74.2% of the groundwater levels decreased, 63.4% of groundwater quality deteriorated, and 79.5% of ecosystems increased. Overall, groundwater environmental risks were primarily influenced by human activities and climatic conditions. Areas with no, light, moderate, serious, and tremendous warning account for 3.2%, 6.6%, 29.8%, 47.1%, and 13.3%, respectively. The high-risk warning zone is determined by the combined influence of multiple indicators. Based on this, a hierarchical control scheme for managing regional groundwater environmental risks is proposed. Overall, the results provide critical theoretical and technical support for the management and remediation of regional groundwater environmental risks.