CEMETERY, FUNERAL PARLORS, CREMATORIUM, AND COLUMBARIUM PROJECTS

INITIAL ENVIRONMENTAL EXAMINATION ( IEE ) CHECKLIST REPORT

for

Project name or Title

Below is the IEE Checklist Report for Cemetery, Funeral Parlors, Crematorium, and
Columbarium. Please check applicable project category:
Projects Project Size Corresponding Project
 Parameter Size/Threshold
Cemetery area to be ≥ 5.0 hectares
developed
total/gross floor ≥ 1 hectare
Funeral parlors, crematorium, area including
columbarium parking and other
areas
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
Landline : _______________________________________________________
Fax Number: _______________________________________________________
Mobile : _______________________________________________________
E-mail Address:

I. PROJECT DESCRIPTION

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

__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________

Attach 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

Cemetery and Funeral Homes

Facilities No. of Units Area (sq. m.) / Specification/

Capacity Description / Remarks

1. Area for internment, vaults,

columbarium, etc.
2. Commercial Area (e.g.
restaurants, food outlets, etc.)
3. Crematorium
4. Wake Chapel, viewing area,
and similar facilities
5. Support facilities (e.g. morgue,
embalming facility, showroom,
etc.)
6. Amenities (e.g. rest room, etc.)
7. Open/Common Spaces (e.g.
reception area, garden, parks,
etc.)
8. Parking area
9. Waste water Management
Facility
10. Solid waste management
facilities
11. Drainage System
12. Others (please specify)
_____________________
_____________________
 (Use additional sheets if needed)
_____________________________________________________________________________________

1.3 UTILITIES/REQUIREMENTS (Operation Phase):

Utilities Source Estimated Demand/Consumption

Power/Electricity KWh
(Total)
Power/Electricity KWh
(From Renewable Energy
Sources)
Water m³/day
(Total)
(Fill-up table below if water is
not obtained from the local
water utility)
Water m³/day
(Rainwater Collection
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 m³/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): ____________

 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 ___________________

Actual land uses w/in 1km radius:

 Residential
 Commercial/ Institutional
 Industrial
 Agricultural/ Recreational
 Protected Areas
 Others ___________________

 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  Marshland
Permit

 Grassland
 Limit land clearing as much as possible

 Mangrove
 Provide temporary fencing for vegetation
that will be retained
 Wetland  Promote restoration of damaged or
 Others, specify destroyed vegetation where possible (e.g.,
____________________ tree planting);
Possible Environmental/
Social Impacts
 Change in surface
landform/ topography/
terrain/slope
 Soil Erosion
Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Implementation
Slope:  Provide erosion control and slope  Regular inspection of slope  Slope/ Erosion Control
 flat (0-3%) protection measures protection measures in Cost: ___________
 gently sloping to rolling (3-18%)  Designate a Spoils Storage Area, with erosion-prone areas  Others, specify
 steep (>18%) topsoil set aside for later use and allow  Regular inspection for new ____________
maximum re-use of spoils eroded areas near the site ____________
 Construction during dry season  Others (Pls. specify):
 Stabilization of embankment with grasses ___________
or other soil cover
 Others, specify:
____________

Is the project site located in an area  Compliance with the DENR Administrative
identified by Order No. 2003-30 and DENR
MGB/PAGASA/PHIVOLCS as Administrative Order No. 2000-28,
hazard prone? Implementing Guidelines on Engineering
 Yes Geological and Geo-hazard Assessment
(EGGA).
 No
 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
 clay  Set-up temporary fence around the segregation

 sandy-loam
construction area  Daily inspection for presence

 Others, specify
 Implement re-use and recycling of waste of mixed garbage in the
materials facility
____________________
 Implement proper segregation, collection  Weekly inspection of waste
and disposal of domestic wastes in accumulated
designated areas  Others, specify
 Implement proper collection, labeling and ___________________________
_______
storage of hazardous waste
 Provide receptacles / bins for solid wastes
 Coordinate with the municipal / city waste
collectors
 Engage third party company for waste
collection
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Others, specify: ________________

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

 Increased siltation due
to project activities
 Water quality
degradation
 Others, specify
______________________
______
Specify nearest/receiving water
body:
____________________________
__
Distance to nearest/receiving water
body:
 0 to less than 0.5 km
 Set-up proper and adequate sanitary
facilities
 Strictly require the contractor and its
workers to observe proper waste disposal
and proper sanitation
 Strictly observe proper waste handling and
disposal
Regular (ocular) inspection of:  Cost integrated in the
 Drainage / canal systems construction/ operation cost
 Water treatment facility (i.e.,
grease trap, septic tank, etc.)
Regular (ocular) inspection of
waterbody for:

 0.5 to 1 km
 Provision of wastewater treatment facility  Turbidity and/or silted
(e.g. septic tank, oil and water separator, condition
 More than 1 km etc.)  Floating wastes or debris
If nearest/receiving water body is  Set up silt trap/stilling ponds to minimize
downstream siltation
fresh water, specify classification:
 AA
 Others (Pls. specify): ___________

 A
 B  Provision of three-chambered septic tank
 C for domestic sewage
 D
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

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

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
Possible Environmental/
Social Impacts
 Competition in water
use
 Depletion of water
resources
Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Implementation
Size of population using receiving  Implement rainwater harvesting and similar  Cost integrated in the
surface water: measures as an alternative source of water  Regularly monitor construction/ operation cost
 ≤ 1,000 persons  Observe water conservation measures;
presence/absence of
 >1,000 and ≤ 5,000persons  Others, specify
complaints

 >5,000person ________________________
 Regular coordination with
concerned agencies
Available/nearest water source.  Regularly monitor
occurrences of water
 Deepwell shortages
 Water district/LGU  Others, specify
 Surface water ____________
 Others, specify
________________________

 Increased occurrence
of flooding
Is the project site located in an area
identified by MGB/PAGASA as
flood prone?
 Use appropriate design for project facilities  Regularly monitor  Cost integrated in the
 Implement appropriate drainage system
presence/absence of
complaints
construction/ operation cost

 Yes  Regularly remove debris and other

 Regular coordination with
materials that may obstruct water flow
 No concerned agencies
 Others, specify:  Regularly monitor increased
_______________________________ frequency of flooding
 Others, specify
_________________

AIR / NOISE

 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. generator, etc) presence/absence of construction/ operation cost
 0.5 to 1 km  Install when applicable, the appropriate air
complaints

 More than 1 km pollution control device/s

Regular (ocular) inspection of:
 Strictly enforce good housekeeping
 Absence of white or black
practices Other, specify
____________________________ smoke from vehicles
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
PEOPLE

 Displacement of  Provide relocation/disturbance  Regularly monitor  Cost integrated in the

residents in the project compensation packages presence/absence of construction/ operation cost
site and within its  Prioritize local residents for employment complaints
vicinity Size of population of host barangay:  Promptly pay local taxes and other  Regular coordination with
 Displacement of  ≤ 1,000 persons financial obligations LGU
Indigenous People
 >1,000 and ≤ 5,000persons  Regular coordination with LGU  Others, specify
 Enhanced
 >5,000person  Prior consultation & coordination to
_________________
employment and/or
minimize disruption on daily domestic
livelihood
Classification of host barangay: activities & respect for IP rights and
opportunities
  Urban
cultural practices
Reduced
employment and/or  Rural
 Ensure participation of IPs in
consultations and dialogues
livelihood
opportunities Available services within/near the  Provide appropriate traffic/warning
 Increased revenues host barangay: signs, lighting, etc
for LGU  Schools (e.g. elementary, high  Others: specify _________________
 Disruption/Competit school, college)
ion in delivery of  Health facilities (e.g., clinics,
public services hospitals, etc.)
(e.g., education,
peace and order,
 Peace and order (e.g., police
outpost, brgy. Tanod, etc.)
etc.)
 Enhanced delivery
 Recreation and sports facilities
of public services  Others, specify:
(e.g., education, ____________________________
peace and order, ___
etc.)
 Increase in traffic
volume and worsening
of traffic flow
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Impacts on community  Regular coordination with LGU  Regularly monitor  Cost integrated in the
health and safety  Provide appropriate warning signs, lighting presence/absence of construction/ operation cost
 Others, specify and barricades, whenever practicable complaints
______________________  Observe proper housekeeping  Regular coordination with
_______ LGU
 Provide on-site medical services for any
 Regularly monitor submission
emergency.
of reports to concerned
 Participate in public awareness programs agency
on health and safety
 Others, specify
_________________
 Others, specify
__________________________
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:

4.1. Abandonment Plan (if Applicable)

Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)
 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 plan 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 ____________________