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GENERIC INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT

for

Project name or Title

This Generic IEE Checklist Report shall be used as the interim pro-forma EIA
Report requirement for projects types where a customized IEE Checklist Report
Form has not yet been developed but are required IEE Checklist Report Form or
IEE Report per the Revised Procedural Manual for DAO 2003-30

For ECC applications, this IEE Checklist Report shall be submitted with:
Proof of Compatibility with the existing Land Use Plan
Proof of Authority over the Project Site
Accountability Statements of Proponent (see attached form) and the Preparer (if
any, following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)
Photographs or plates/vicinity map of the project site showing impact areas and
affected areas and communities
Duly Accomplished Project Environmental Monitoring & Audit Prioritization
Scheme (PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO
2003-30)
(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14)

Read the questions carefully and write the required information on the blank spaces
provided or otherwise check () the appropriate boxes or parenthesis ( ). Boxes with
check marks () are automatically required. Use additional sheets if necessary and
indicate this in the appropriate space.

Project proponents are strongly discouraged to engage the


services of consultants/facilitators/preparers to accomplish/fill-up
the IEE Checklist Report Form. The Report Forms have been
designed to be user-friendly.

Furthermore, EMB Regional Office is required to complete the


processing of an ECC application using the IEE Checklist Report
within twenty (20) working days upon receipt for completed/duly-
accomplished form.
Misleading or erroneous answers are basis for legal actions and/or denial of ECC
issuance.

PROJECT FACT SHEET

Project Name: _______________________________________________________


Project Location: _______________________________________________________

Total Project Land Area: _______________________________________________________

Total Project/Building
Footprint Area _______________________________________________________
(Area actually utilized)
Project Proponent: _______________________________________________________
_______________________________________________________
Office Address:
Contact Person: _______________________________________________________
Designation: _______________________________________________________
Contact Number/s

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
Landline : _______________________________________________________
Fax Number: _______________________________________________________
Mobile : _______________________________________________________
E-mail Address: _______________________________________________________

I. PROJECT DESCRIPTION

1.1 PROJECT LOCATION AND AREA: Street Name, Barangay, and Municipality/City, Province

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

See attached vicinity map/s and photographs of the project site and site development/layout plan.

Geographic coordinates of the project area (Preferably use WGS 84 datum,


otherwise specify datum used).
Perimeter/Boundary points
Longitude Latitude
(based on OCT/TCT/etc)

1.2 PROJECT COMPONENTS

Area (sq. m.) / Specification/


Facilities No. of Units
Capacity Description / Remarks

Support Facilities (e.g. emergency


generators, boilers, etc.)
Admin support (e.g., canteen, office,
clinic, quarters, etc.)
Water source / supply

Waste water management Facility

Solid waste management facility

Drainage system
(Please list facilities by module/grouping. Use additional sheets if needed)

1.3 UTILITIES/REQUIREMENTS (Operation Phase):

Utilities Source Estimated Demand/Consumption


Power/Electricity KWh

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
(Total)
Power/Electricity
(From Renewable Energy KWh
Sources)
Water
(Total)
(Fill-up table below if water is Cubic meters/day
not obtained from the local
water utility)
Water
(Rainwater Collection
Cubic meters/day
System)

Water Source
[ ] ground water [ ] well [ ] spring [ ] others: ____________________________

[ ] Surface water [ ] river [ ] lake [ ] others: ____________________________

Location of water source


__________________________________________________________________________
(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh

Water Cubic meters/day

1.4 MANPOWER

a. Construction Phase
Manpower Expertise/Skills Total
Requirement

b. Operation Phase
Manpower Expertise/Skills Total
Requirement

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
II. ENVIRONMENTAL IMPACTS AND MANAGEMENT PLAN

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
LAND
Consistency with land Current land use w/in 1km radius See attached proof of compatibility with
use (as per zoning ordinance): land use
Residential
Commercial/ Institutional
Industrial
Agricultural/ Recreational
Protected Areas
Others, specify
___________________

Actual land uses w/in 1km radius:


Residential
Commercial/ Institutional
Industrial
Agricultural/ Recreational
Protected Areas
Others, specify
___________________

Disturbance to wildlife
Existing vegetation in the area: Compliance with conditions of DENR/LGU Annual inspection of area Cost integrated in the
due to vegetation Forestland SLUP, Tree Cutting Permit, ROW, PCA replanted/ revegetated construction /operation cost
clearing Permit
Marshland
Limit land clearing as much as possible

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Grassland Provide temporary fencing for vegetation
that will be retained
Mangrove
Promote restoration of damaged or
Wetland destroyed vegetation where possible (e.g.,
tree planting);
Others, specify
____________________
Slope:
Change in surface Provide erosion control and slope Regular inspection of slope Slope/ Erosion Control
landform/ topography/ flat (0-3%) protection measures protection measures in Cost: ___________
terrain/slope erosion-prone areas
gently sloping to rolling (3-18%) Designate a Spoils Storage Area, with Others, specify
topsoil set aside for later use and allow Regular inspection for new ____________
Soil Erosion steep (>18%)
maximum re-use of spoils eroded areas near the site
Construction during dry season Others, specify
___________
Stabilization of embankment with grasses
or other soil cover
Others, specify
____________
Is the project site located in an area
identified by Compliance with the DENR Administrative
MGB/PAGASA/PHIVOLCS as Order No. 2003-30 and DENR
hazard prone? Administrative Order No. 2000-28,
Yes Implementing Guidelines on Engineering
Geological and Geo-hazard Assessment
No (EGGA).

Soil/Land contamination Existing soil type in the area: Implementation of the Ecological Solid Daily inspection of Cost integrated in the
due to improper solid sandy Waste Management Plan (ESWMP) waste/recycling bins for construction /operation cost
waste disposal segregation
clay Set-up temporary fence around the
construction area Daily inspection for presence
sandy-loam
Implement re-use and recycling of waste
of mixed garbage in the
facility
Others, specify materials
Weekly inspection of waste

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
____________ Implement proper segregation, collection accumulated
and disposal of domestic wastes in Others, specify
designated areas _____________
Provide receptacles / bins for solid wastes
Coordinate with the municipal / city waste
collectors
Engage third party company for waste
collection
Others, specify ________________

Impairment of visual
Presence of visually significant
Implement landscaping and other Regular inspection of Cost integrated in the
landforms/landscape/structures? construction/ operation cost
aesthetics beautification measures landscaping and other
Yes beautification activities
Devaluation of land Provide adequate buffer
values No Regular monitoring of buffer
Compensate adjacent property owners
zones
Others, specify Regularly monitor
________________ presence/absence of
complaints from adjacent
property owners
WATER

Increased siltation due


Specify nearest/receiving water Set-up proper and adequate sanitary Regular (ocular) inspection of: Cost integrated in the
body:
to project activities ____________________________
facilities Drainage / canal systems construction/ operation cost

Water quality
Strictly require the contractor and its
Water treatment facility (i.e.,
Distance to nearest/receiving water workers to observe proper waste disposal
degradation and proper sanitation grease trap, septic tank, etc.)
body:
Others, specify
0 to less than 0.5 km Strictly observe proper waste handling and Quarterly monitoring of the
___________________ disposal following:
0.5 to 1 km
Provision of wastewater treatment facility pH
More than 1 km (e.g. septic tank, oil and water separator,
etc.) TSS concentration
If nearest/receiving water body is Set up silt trap/stilling ponds to minimize BOD

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
fresh water, specify classification: downstream siltation
Total Coliform
AA Provision of three-chambered septic tank
for domestic sewage
Color
A
Provide ring canals around fuelling tanks/ Oil and Grease
B
motorpool/ maintenance areas
C Others, specify
D ___________

If nearest/receiving water body is


coastal or marine water, specify
classification:
SA
SB
SC
SD

Current Water Use:


Fishery
Tourist Zone / Park
Recreational
Industrial
Agricultural

Distance of project area to the

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
nearest well used:
0 to less than 0.5 km
0.5 to 1 km
More than 1 km

Use of the nearest well:


Drinking/Domestic
Industrial
Agricultural

Competition in water
Size of population using receiving
Implement rainwater harvesting and similar Regularly monitor Cost integrated in the
surface water: presence/absence of construction/ operation cost
use measures as an alternative source of water
1,000 persons complaints
Depletion of water Observe water conservation measures;
Regular coordination with
resources >1,000 and 5,000persons
Careful selection of project site to avoid concerned agencies
>5,000person disruption of traditional water uses Regularly monitor
occurrences of water
Available/nearest water source.
Obtain Water Permit from NWRB
shortages
Deepwell Improve efficiency of water supply and Others, specify
distribution system ____________
Water district/LGU
Others, specify
Surface water _____________________
Others, specify
________________________

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Increased occurrence
Is the project site located in an area
Use appropriate design for project facilities Regularly monitor Cost integrated in the
identified by MGB/PAGASA as flood presence/absence of construction/ operation cost
of flooding prone? Implement appropriate drainage system complaints
Yes Regularly remove debris and other Regular coordination with
concerned agencies
No materials that may obstruct water flow
Regularly monitor increased
Use appropriate technology (e.g. raised
frequency of flooding
hand-pumps) to protect drinking water from
flood contamination Others, specify
_________________
Others, specify
_____________________

AIR / NOISE

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Air quality degradation
Distance to nearest community:
Properly operate and maintain all emission Regularly monitor Cost integrated in the
0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
etc) complaints
0.5 to 1 km
Install when applicable, the appropriate air Regular (ocular) inspection of:
More than 1 km
pollution control device/s Absence of white or black
Strictly enforce good housekeeping smoke from vehicles,
practices heavy equipment and
generator
Control vehicle speed to lessen
suspension of road dust Presence of truck cover
during deliveries
Conduct water spraying to suppress dust
sources and minimize discomfort to nearby
residents
Use covered vehicles to deliver materials
that may generate dust
Other, specify
___________________

Nuisance due to noise


Distance to nearest community:
Properly operate and maintain all noise Regularly monitor Cost integrated in the
generation 0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
etc) complaints
0.5 to 1 km
Regular monitoring of buffer
Install when applicable, the appropriate
More than 1 km
noise control device/s (e.g., mufflers, zones
silencer, sound barriers, etc.)
Implement appropriate operating hours
Provide adequate buffer and/or planting of
trees
Others, specify
______________________

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

PEOPLE

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Displacement of
Size of population of host barangay:
Provide relocation/disturbance Regularly monitor Cost integrated in the
residents in the project 1,000 persons compensation packages presence/absence of construction/ operation cost
complaints
site and within its
>1,000 and 5,000persons Prioritize local residents for employment
vicinity Regular coordination with
Promptly pay local taxes and other LGU
Displacement of >5,000person
financial obligations
Indigenous People Regular coordination with LGU
Others, specify
Classification of host barangay: _________________
Enhanced employment Prior consultation & coordination to
and/or livelihood
Urban
minimize disruption on daily domestic
opportunities Rural activities & respect for IP rights and
Reduced employment cultural practices
and/or livelihood Available services within/near the Ensure participation of IPs in consultations
opportunities host barangay:
and dialogues
Increased revenues for Schools (e.g. elementary, high
Provide appropriate traffic/warning signs,
LGU school, college)
lighting, etc
Disruption/Competition Health facilities (e.g., clinics,
Others, specify
in delivery of public hospitals, etc.)
________________
services (e.g., Peace and order (e.g., police
education, peace and outpost, brgy. Tanod, etc.)
order, etc.)
Enhanced delivery of
Recreation and sports facilities

public services (e.g., Others, specify


education, peace and _____________________
order, etc.)
Increase in traffic
volume and worsening
of traffic flow

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Impacts on community Regular coordination with LGU Presence/Absence of Cost integrated in the
complaints construction/ operation cost
health and safety Provide appropriate warning signs, lighting
Others, specify and barricades, whenever practicable Regular coordination with
LGU
_______________ Observe proper housekeeping
Regular submission of reports
Provide on-site medical services for any to concerned agency
emergency. Others, specify
Participate in public awareness programs _________________
on health and safety

Implement appropriate safety programs for


both community and workers
Strictly comply with fire, safety and similar
regulatory requirements
Strictly comply with requirements of RA
6969
Others, specify
______________________

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND
GENERIC GUIDELINES (if Applicable)

Project Life or Service: ___________ years

Provide description of the Abandonment activities, such as, dismantling and waste
disposal.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION

Organization Chart:

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT

This is to certify that all the information and commitments in this Initial
Environmental Examination (IEE) Checklist Report are accurate and complete to
the best of my knowledge.

By the authority vested in me by the ___(Company Name) as


___(Position/Designation), I hereby commit to ensure implementation of all
commitments, mitigating measures and monitoring requirements indicated in this
IEE Checklist Report as well as the following:
Conform with pertinent provisions of applicable environmental laws
e.g., R.A. No. 6969 (Toxic Substances and Hazardous and Nuclear
Wastes Control Act of 1990), R.A. No. 9003 (Ecological Solid
Waste Management Act of 2000), R.A. No. 9275 (Philippine Clean
Water Act of 2004), and R.A. No. 8749 (Philippine Clean Air Act of
1999).
Abide and conform to LGU development plans and guidelines.
Promptly pay local taxes and other financial obligations.
Regularly submit reports to concerned agencies.

I hereby bind myself to answer any penalty that may be imposed arising
from any misrepresentation or failure to state material information in this IEE
Checklist.

In witness whereof, I hereby set my hand this ____ day of __________ at


______________________.

__________________________
NAME OF PROPONENT HEAD
(Position)
(Company Name)

SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant
exhibiting his/her Community Tax Certificate No. ___________________ issued at
______________________ on __________________________.

Doc. No. ____________________


Page No. ____________________
Book No. ____________________
Series of ____________________

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities

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