IEE Checklist for

Funeral Parlor

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST

for

FUNERAL PARLOR

1.0 GENERAL INFORMATION

1.1 Project Name/Title : _____________________________________

1.2 Proponent/Company :_____________________________________

Address __________________________________________
(complete address: street/sitio, barangay, city/municipality, province)

_____________________________________________

Tel/Fax _____________________________________________

E-mail _____________________________________________

1.3 Project Location _____________________________________________

(complete address: street/sitio, barangay, city/municipality, province)

(attach location map with important landmarks and access points indicated as Annex 1)

1.4 Project Objectives: _______________________________________

_______________________________________

_______________________________________

1.5 Project Ownership:

[ ] Single Proprietorship[ ] Corporation

[ ] Partnership/Joint Venture [ ] Cooperative

[ ] Others, pls. specify: ___________________

1.6 Project Cost __________________________ (range)

1.7 Duration of construction ______________________ months

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 IEE Checklist for
Funeral Parlor

2.0 PROJECT DESCRIPTION

2.1 Project Area Coverage

(Attach photocopies of documents as Annex______)

Total Land Area (m2/ha) ________________

2.2 Land Ownership

 Ownership of the land by virtue of OCT/TCT # ____________

Stewardship of land by virtue of : ______________________

Lease of Land by virtue of: _____________________________

Pending Application for: ________________________________

Others, please specify: _________________________________

2.3 General Land Classification

[ ] Public land [ ] A and D

2.4 Present Land Use Classification (based on the approved land use/zoning ordinance of the
city/municipality)

[ ] Agricultural [ ] Residential [ ] Tourism

[ ] Industrial [ ] Forest Land [ ] Institutional
[ ] Commercial [ ] Open Spaces [ ] Others, Pls. specify:
__________________________
__________________________
_________________

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 IEE Checklist for
Funeral Parlor

attach panoramic view of the project site and its immediate vicinity (north side view).

attach panoramic view of the project site and its immediate vicinity (south side view).

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 IEE Checklist for
Funeral Parlor

2.5 Services

Services No. of Area Capacity No. of Chemical to Vol. of

Unit (m2) Responsible be Used Water to be
Person Used
1. Embalming
2. Display Services
3.
4.
5.
6.
7.
8. Others, pls., specify

2.6 Facilities

Facility No. of Unit Area (m2) Capacity

1. Fabrication Shop
2. Garage
3.
4.
5.
6.
8. Others, pls. specify

(attach facilities design/lay-out plan)

General lay-out plan of the gasoline station.

2.7 Water Supply/Sources

 Existing Public Water

Water Source Yes No Remarks

 Existing Public Water

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 IEE Checklist for
Funeral Parlor

 Surface Water

Water Source Name of Location Distance Mode of Volume of

Water dev't. or Extraction
Body distribution
1. Creek
2. Spring
3. Stream
4. River
5. Others

 Deep Well

Water Source Name of Location Depth Discharge

Wells/Hand (m) (liter/sec)
Pump/Tanks
1. Deep Well w/
Manual Hand Pump
2. Deep Well w/
Electric or Motor Pump

 Rainwater

Water Source No. of Capacity

Tanks/Reservoirs
1. Collected in Storage Tank
2. Collected in Reservoir

 Water Treatment

Is there provision for water treatment of your independent water source?

[ ] Yes [ ] No

If yes, what type of water treatment?

Chlorination Filtration Others (specify) __________________

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Funeral Parlor

2.8 Drainage System (Attach approved drainage layout plan as Annex)

Type of drainage:

a) Major Roads: [ ]open canal [ ] closed/underground drainage

b) Other roads: [ ]open canal [ ] closed/underground drainage

Where does the drainage system drain?

Public drainage system natural outfall/water body

What water body (e.g. river/creek/stream) will serve as the outfall of the sewage and drainage
systems? _______________________________________

Where is this located: ________________________________________________

2.9 Power Supply

Source of Power: Local Electric Cooperative

Own Generator Capacity: _____________

Others, pls. specify ___________________________

3.6 Sewage Disposal System

 Sewage System Individual Septic Tank Communal Septic Tank

 Sewage Design 3-chamber septic tank w/ leaching

3-chamber septic tank w/o leaching

4-chamber septic tank w/ leaching

4-chamber septic tank w/o leaching

Others, pls. specify ____________________

 Sewage Disposal [ ] discharge to an existing public

sewerage system.

[ ] treated in a community disposal plant or communal septic

tank

[ ] Treatment in individual septic tanks with disposal by

absorption field or leaching pit

[ ] Others:

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 IEE Checklist for
Funeral Parlor

(Specify)_______________________________

2.10 Solid Waste Disposal System

 Collection System

[ ] Association/project-maintained garbage collection system

[ ] Integrated into the municipal garbage collection system
[ ] Others, (specify): _____________________________________

 Will there be a waste sorting/segregation system to be employed prior to disposal?

[ ] Yes [ ] No

 Disposal System [ ] Burning at open dumpsite in the project site

[ ] Sludge cleaning
[ ] Open dumpsite outside of the project site
[ ] Municipality/City landfill area
[ ] Others, specify: _________________________

 Location of the waste disposal site: _____________________________

Attach flow plan of solid waste management - collection to disposal.

2.12 Manpower and Employment (provide listing of manpower requirements as Annex

 How many people will be employed by the proposed funeral parlor during:

a) Pre-construction Period: ________________

b) Operation and Maintenance Period: ___________

2.13 Project Schedule (Attach schedule of development activities from pre-construction; construction;
operation phase)

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3.0 DESCRIPTION OF EXISTING ENVIRONMENT

A. Physical Environment

Components/Parameters Y N Remarks
1. What is the general elevation of the proposed funeral
parlor?

<100 masl
100-300 masl
301-500 masl
501-1000 masl
1,000-1,500 masl
>1,500 masl
(To determine elevation, refer to the topographic map
where the elevation per contour line is indicated)
2. Slope and topography of the area
Terrain is flat or level (0-3% slope)
Gently sloping to undulating (3-8 slope)
Undulating to rolling (8-18% slope)
Rolling to moderately steep (18-30% slope)
3. Are there areas in the site where indications of soil Causes of erosion:
erosion are occurring? If yes, what activities are causing ( ) Heavy Rains
erosion? ( ) Unstable Slopes
( ) Others, pls specify
___________________
4. Do you know of any landslide occurring or that has
occurred in the site?

A. Physical Environment

Components/Parameters Y N Remarks
5. Has the area experienced any flooding during the wet Period(s) of flooding:
season or typhoons? If yes, when was the last time the area ___________________
was flooded? What caused the flooding? Causes of flooding:
( ) low area
( ) poor drainage
( ) water logged areas
6. Soil type of the area: Cause of Landslide:
( ) Earthquake
( ) Sandy soil ( ) Unstable slopes
( ) Clayey soil ( ) Earthmoving
( ) Sandy loam soil ( ) Others, pls. specify

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Components/Parameters Y N Remarks
7. Are there existing water bodies found near or within the Name of water bodies
site e.g. creeks or streams? If yes, please enumerate them
in the opposite space and indicate their location

(if they have no names, indicate the number of water

bodies)
* these water bodies should be shown in the topographic
map
What are the present uses of the water bodies within or near
the project site?

( ) Bathing
( ) Washing
( ) Fishing
( ) Source of drinking water
( ) Recreation (swimming, boating, etc.)
( ) Others: __________________________
8. Is there an access road going to the project site? Type of access road:
If yes, what is its distance to the site ________ km.
_______________________
_______________
9. What is the present land use of the area wherein the
proposed gasoline and refuelling station be located?

( ) Prime agricultural land (productive/irrigated)

( ) Prime agricultural land (idle/ abandoned)
( ) Grassland
( ) Built-up
( ) Orchard
( ) Marshal/Mangrove
( ) Fishpond
( ) Others, pls. specify: _____________
Does the site conform to the approved land use of the
city/municipality?
10. Is the land allocation and alignment of the various
utilities integrated with the existing network and projects
outside of the boundaries of the project site?
11. Are there existing structure or developments around the
project site? If yes, please list them in the opposite space

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B. Biological Environment

Components/Parameters Y N Remarks
1. Is the funeral parlor adjacent to a natural ecosystem?

( ) Forest
( ) Coastal/Marine
( ) Grassland
( ) Mangrove
( ) Agriculture

C. Socio-Economic Environment

Components/Parameters Y N Remarks
1. Are there existing settlements in the proposed funeral
parlor? If yes, indicate the number of: (within 100 m
radius)

Household/Families: _______________
Legitimate landowners: ____________
Tenants: __________________________
Squatters: ________________________
2. What is the total population of the community in the
project site?
3. Average family size: ________________
4. What are their source(s) of livelihood?
Livelihood Type
[ ] Farming
[ ] Fishing
[ ] Backyard poultry and piggery
[ ] Vending/Buy and Sell
[ ] Sari-sari store
[ ] Others, Pls. specify: _____________

5. How many of the total population have reached the:

Elementary level: _______________

High School level: ______________
College level: __________________

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Components/Parameters Y N Remarks
6. Are there other existing local organizations in the area? List of Organized Groups

7. Are there existing social infrastructures in the barangay? List of Organized Groups
_______________________
[ ] Schools _______________________
[ ] Communications ___________
[ ] Health centers/clinics
[ ] Hospitals
[ ] Churches/Chapel
[ ] Transportation
[ ] Roads
[ ] Others, Pls. specify ____________

5.0 IMPACT ASSESSMENT AND MITIGATION

Predicted Impacts Significance of Impacts Mitigating/Enhancement

Measures
+/- D/In L/S R/I Mitigating/Enhancement
Measures
A. PRE-CONSTRUCTION/CONSTRUCTION PHASE
Land clearing in an area equal to  Limit land clearing as much
_____ sq. m. and loss of as possible
vegetation  Provide temporary fencing to
vegetation that will be
retained
 Use of markers and fences to
direct heavy equipment
/vehicles within the site and
avoid damage to plans

Tree cutting of ---- no. of trees  Re-plant/plant indigenous

tree species and ornamental
plants
Pollution of nearby water body  Set-up temporary disposal
due to improper disposal of mechanism within the
construction wastes construction area and
properly dispose the
generated solid wastes
 Set up proper and adequate
toilet facilities
 Strictly require the contractor
and its workers to observe

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Noise generation during
construction that can affect the
nearby residents
Generation of employment
Conflicts in right of way
B. OPERATION PHASE
Increase in traffic and possible
congestion
Generation of liquid wastes the
activities of the funeral parlor
Generation of solid wastes
Pollution of the nearby water
body due to effluents and solid
wastes from the funeral parlor
Hiring of qualified locals
Competition and conflict due to
high water demand of the project
Increase in local revenue
Legend:
(+) positive impact
D – direct impact
L – long term
R – reversible
IEE Checklist for
Funeral Parlor
proper waste disposal and
proper sanitation
 Schedule noisy construction
activities during day time
 Undertake proper
maintenance of equipment
and use mufflers
Hiring priority shall be given to
qualified local residents
Conduct consultation and settle
agreements before finalizing
detailed design
Strict enforcement of traffic rules
and regulations
Placement of signage and
warnings in appropriate places
 Provision of an effective
collection and disposal
system
 Provision of adequate and
appropriate hematic tanks
 Provision of adequate waste
water treatment facilities
 Segregation of recyclable
materials
 Proper collection and
disposal of solid wastes
 Proper housekeeping and
waste minimization
 Avoid disposal of liquid and
solid wastes to the nearby
water body.
Hiring priority shall be given to
qualified locals
Ensure sufficient independent
water supply
Diligently pay local taxes
(-) negative impact
In – indirect impact
S – short term
Ir - irreversible
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Funeral Parlor

5.0 ENVIRONMENTAL MANAGEMENT PLAN (EMP)

Project Impacts Mitigating Measures Cost Responsible Guarantee

Activity Phase Person/Unit
(Indicate here all (Indicate here all
possible impacts mitigating measures
listed in section 4 corresponding to the
identified impacts)

6.0 PROPONENT'S COMMITMENTS

I/We, am/are committing to . . . . . . .

1. Comply with existing environmental rules and regulations, guidelines and criteria;
2. Comply with all mitigation/enhancement measures that have been identified in the report;
4. Construct, maintain and properly operate an adequate and appropriate hematic septic tanks/dust
collection system;
5. Construct, maintain and properly operate an adequate and appropriate septic tank for the liquid
wastes;
6. Maintain the cleanliness of the general surroundings;
7. Participate or contribute towards a communal cleaning effort;
8. Strictly implement a contingency management plan and safety program;
9. Organize and conduct information, education and communication (IEC) activities on
environmental, health and other civic issues;
10. Others, which may be prescribed by DENR

__________________________________
Signature of the Proponent

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Funeral Parlor

7.0 ATTACHMENTS/ANNEXES

A. Government Permits and Clearances (Attach photocopies of documents)

PERMITS/CLEARANCES YES NO
Location Map/Vicinity Map
Documents Pertaining to land ownership i.e. TCT, OCT, TD)

Design/Plan of the Funeral Parlor

Drainage Layout Plan

Sewage design layout

Location Clearance from HLURB or local Government Unit

NWRB Permit
Listing of manpower requirements

Schedule of activities from pre-construction, construction and operation phase

Pictures of the proposed site

Payment of filing and processing fees: P 2,130.00

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Funeral Parlor

ACCOUNTABILITY STATEMENT

This is to certify that all the information and commitment in this Initial Examination (IEE)
Report are true, accurate and complete. Should I/we learn of any information which would make the IEE
inaccurate, I/we shall bring said information to the attention of the appropriate EMB DENR Regional
Office.

I/We hereby bind myself/ourselves jointly and solidarily for any penalties that may be imposed
from any misrepresentations or failure to state material information in the IEE.

In witness whereof, I/we hereby set out hands this ________________ day of
______________________ at _____________________________________________.

_________________________________
Project Proponent

_________________________________
Title/Designation

ACKNOWLEDGMENT

BEFORE ME this ____________ day of _________________________, 19 ____ at ________

personally/appeared _______________________________________ with Community Tax Certificate
No. __________ issued on ________________________ at
_____________________________________, in his/her capacity as ___________
______________________________ of _____________________________________ and
acknowledged to me that this IEE Report is his voluntary act and deed, and the voluntary act and deed of
the entity he/she represents. This document, which consists of _______ pages., including the page on
which this acknowledgement is written, is an Initial Environmental Examination Report Checklist.

______________________________
Notary Public

Doc. No. ________

Page No. ________
Book No. ________

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 IEE Checklist for
Funeral Parlor

Series of _______

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