PH LC 6.

4
MU BNG TNG HP HOT NG THM NH BO CO
NH GI MI TRNG CHIN LC; THM NH, PH DUYT
BO CO NH GI TC NG MI TRNG; KIM TRA,
XC NHN HON THNH CNG TRNH BO V MI TRNG;
NG K V XC NHN NG K K HOCH BO V
MI TRNG CA Y BAN NHN DN CP TNH
(Ban hnh km theo Thng t s 27/2015/TT-BTNMT ngy 29 thng 5 nm 2015
ca B trng B Ti nguyn v Mi trng v nh gi mi trng chin lc,
nh gi tc ng mi trng v k hoch bo v mi trng)
BNG TNG HP HOT NG THM NH BO CO NH GI
MI TRNG CHIN LC; THM NH, PH DUYT BO CO
NH GI TC NG MI TRNG; KIM TRA, XC NHN HON
THNH CNG TRNH BO V MI TRNG; NG K
V XC NHN NG K K HOCH BO V MI TRNG
nm ...(*)
(km theo Vn bn s... ngy... thng... nm... ca...)
- Tn c quan bo co: ...
- a ch lin h: ...
- in thoi: ...; Fax: ...; E-mail...
TT 1 2 3 4 5
I Thm nh bo co nh gi mi trng chin lc
1

II Thm nh, ph duyt bo co nh gi tc ng mi trng
1

III Kim tra, xc nhn hon thnh cng trnh bo v mi trng
1

IV ng k v xc nhn ng k k hoch bo v mi trng
1

 NGI LP BNG TH TRNG C QUAN
(K, ghi r h tn) (K, ghi h tn, chc danh, ng du)
Ghi ch:
(*) K bo co thc hin theo quy nh ti Khon 2 iu 21 Ngh nh s
18/2015/N-CP;
Bo co tng hp kt qu nu trn trnh by trn nn Microsoft Excel, s dng
bng m chun quc t Unicode, font Times New Roman ting Vit theo cc ni
dung sau y:
Ct 1: Lit k tt c tn:
- Cc chin lc, quy hoch, k hoch c thm nh bo co nh gi mi
trng chin lc (MC) trong nm bo co i vi mc I;
- Cc d n c ph duyt bo co nh gi tc ng mi trng (TM)
trong nm bo co i vi mc II;
- Cc d n c ph duyt bo co TM v cp giy xc nhn vic hon
thnh cng trnh bo v mi trng phc v giai on vn hnh trong nm bo
co i vi mc III;
- Cc d n, phng n sn xut, kinh doanh, dch v c xc nhn ng k
k hoch bo v mi trng i vi mc IV;
Ct 2: Phm vi ca chin lc, quy hoch, k hoch i vi mc I; a im thc
hin d n, phng n sn xut, kinh doanh, dch v (ghi c th a danh cp x,
huyn, tnh hoc ghi tn khu sn xut, kinh doanh, dch v tp trung i vi cc d
n nm trong cc khu ny km theo a danh cp huyn, tnh) i vi cc mc II,
III, IV;
Ct 3: Ngy nhn c y h s hp l: H s ngh thm nh bo co
MC i vi mc I; h s ngh thm nh, ph duyt bo co TM i vi mc
II; h s ngh kim tra, xc nhn vic thc hin cc cng trnh bo v mi
trng phc v giai on vn hnh ca d n i vi mc III; h s ng k k
hoch bo v mi trng i vi mc IV;
Ct 4: Ghi y s, ngy, thng, nm ca cc vn bn: Vn bn bo co kt qu
thm nh bo co MC i vi mc I; quyt nh ph duyt bo co TM i vi
mc II; giy xc nhn hon thnh cng trnh bo v mi trng phc v giai on
vn hnh ca d n i vi mc III; giy xc nhn ng k k hoch bo v mi
trng i vi mc IV;
Ct 5: Ghi ch nhng vn khc lin quan n cng tc thm nh bo co
MC; thm nh, ph duyt bo co TM; kim tra, xc nhn hon thnh cng
trnh bo v mi trng phc v giai on vn hnh ca d n; xc nhn ng k
k hoch bo v mi trng.