GENERIC IEE Checklist Form093011

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: _______________________________________________________
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
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
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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
(Total)
Power/Electricity
(From Renewable Energy KWh
Sources)
Water Cubic meters/day
(Total)
(Fill-up table below if water is
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): ____________
II. ENVIRONMENTAL IMPACTS AND MANAGEMENT PLAN
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
LAND
þ Consistency with land Current land use w/in 1km radius þ 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: þ Compliance with conditions of DENR/LGU þ Annual inspection of area þ Cost integrated in the
due to vegetation  Forestland SLUP, Tree Cutting Permit, ROW, PCA replanted/ revegetated construction /operation cost
Permit
clearing
 Marshland
þ Limit land clearing as much as possible
 Grassland þ Provide temporary fencing for vegetation
that will be retained
 Mangrove
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
 Wetland þ Promote restoration of damaged or
Others, specify destroyed vegetation where possible (e.g.,
____________________ tree planting);
 Change in surface
Slope:
 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
 gently sloping to rolling (3-18%)  Designate a Spoils Storage Area, with
erosion-prone areas
 Others, specify
 Regular inspection for new
 Soil Erosion  steep (>18%)
topsoil set aside for later use and allow
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
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).
þ Soil/Land contamination Existing soil type in the area: þ Implementation of the Ecological Solid þ Daily inspection of þ 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
construction area þ Daily inspection for presence
 sandy-loam
þ Implement re-use and recycling of waste
of mixed garbage in the
facility
 Others, specify materials
þ Weekly inspection of waste
____________________ þ Implement proper segregation, collection accumulated
and disposal of domestic wastes in
designated areas  Others, specify
þ 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 þ Cost integrated in the
landforms/landscape/structures? construction/ operation cost
aesthetics beautification measures landscaping and other
 Yes
 Devaluation of land  Provide adequate buffer
beautification activities
 No  Regular monitoring of buffer
values
 Compensate adjacent property owners
zones
 Others, specify: ________________ þ Regularly monitor
presence/absence of
complaints from adjacent
property owners
WATER
 Increased siltation due

Specify nearest/receiving water þ Set-up proper and adequate sanitary Regular (ocular) inspection of: þ Cost integrated in the
to project activities
body:
____________________________
facilities  Drainage / canal systems construction/ operation cost
 Water quality __ þ Strictly require the contractor and its

 Water treatment facility (i.e.,
workers to observe proper waste disposal
degradation and proper sanitation grease trap, septic tank, etc.)
Distance to nearest/receiving water
 Others, specify body:  Strictly observe proper waste handling and Quarterly monitoring of the
______________________
______
 0 to less than 0.5 km disposal following:
 0.5 to 1 km
þ Provision of wastewater treatment facility  pH
(e.g. septic tank, oil and water separator,
 More than 1 km etc.)  TSS concentration
 Set up silt trap/stilling ponds to minimize  BOD
If nearest/receiving water body is downstream siltation
fresh water, specify classification:  Total Coliform
  Provision of three-chambered septic tank
AA
for domestic sewage
 Color
 A  Provide ring canals around fuelling tanks/  Oil and Grease
 B
motorpool/ maintenance areas
 Others (Pls. specify): ___________
 C
 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

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 þ Regularly monitor þ 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;
þ Regular coordination with
 >1,000 and ≤ 5,000persons
resources
 Careful selection of project site to avoid concerned agencies
 >5,000person disruption of traditional water uses þ 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
________________________
 Increased occurrence
Is the project site located in an area
 Use appropriate design for project facilities þ Regularly monitor þ Cost integrated in the
identified by MGB/PAGASA as presence/absence of construction/ operation cost
of flooding flood prone?  Implement appropriate drainage system complaints
 Yes  Regularly remove debris and other þ Regular coordination with
 No materials that may obstruct water flow concerned agencies
 Use appropriate technology (e.g. raised þ Regularly monitor increased
hand-pumps) to protect drinking water from frequency of flooding
flood contamination  Others, specify
 Others, specify: _________________
_______________________________
AIR / NOISE
 Air quality degradation

Distance to nearest community:
 Properly operate and maintain all emission þ Regularly monitor þ Cost integrated in the
 0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
complaints
 0.5 to 1 km
etc)
 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 þ Regularly monitor þ Cost integrated in the
generation  0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
complaints
 0.5 to 1 km
etc)

 Install when applicable, the appropriate Regular monitoring of buffer
 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
_____________________________
PEOPLE
 Displacement of
Size of population of host barangay:
 Provide relocation/disturbance þ Regularly monitor þ 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 þ Prioritize local residents for employment
vicinity þ Regular coordination with
 þ Promptly pay local taxes and other
 Displacement of >5,000person
financial obligations
LGU
Indigenous People þ Regular coordination with LGU
 Others, specify
Classification of host barangay:
 Enhanced employment 
_________________
and/or livelihood
 Urban Prior consultation & coordination to
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
host barangay:
 Ensure participation of IPs in consultations
opportunities 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.,
education, peace and
 Peace and order (e.g., police
order, etc.) outpost, brgy. Tanod, 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
 Impacts on community þ Regular coordination with LGU þ Presence/Absence of þ Cost integrated in the
health and safety  Provide appropriate warning signs, lighting
complaints construction/ operation cost
 Others, specify and barricades, whenever practicable þ Regular coordination with

LGU
______________________ þ Observe proper housekeeping
þ 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
þ Strictly comply with fire, safety and similar
regulatory requirements
 Strictly comply with requirements of RA
6969
 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:
Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)
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 with 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 ____________________

GENERIC IEE Checklist Form093011

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

GENERIC IEE Checklist Form093011

Uploaded by

Copyright:

Available Formats

GENERIC INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT

Project name or Title

Project proponents are strongly discouraged to engage the

Furthermore, EMB Regional Office is required to complete the

PROJECT FACT SHEET

Project Name: ____ __________________________________________________

Total Project Land Area: _______________________________________________________

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

1.2 PROJECT COMPONENTS

Area (sq. m.) / Specification/

Support Facilities (e.g. emergency

Waste water management Facility

Solid waste management facility

1.3 UTILITIES/REQUIREMENTS (Operation Phase):

Utilities Source Estimated Demand/Consumption

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

Location of water source

Water Cubic meters/day

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

Actual land uses w/in 1km radius:

 Increased siltation due

 Water quality __ þ Strictly require the contractor and its

If nearest/receiving water body is

Current Water Use:

Distance of project area to the

Use of the nearest well:

 Air quality degradation

 Nuisance due to noise

 Enhanced delivery of  Recreation and sports facilities

 Others, specify and barricades, whenever practicable þ Regular coordination with

 Implement appropriate safety programs for

Project Life or Service: ___________ years

IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION

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

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

Doc. No. ____________________

You might also like

Project Name: ______________________________________________

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