01

SUBPROJECT SCREENING FORM

Region: ........................... Zone...............................Woreda: ……………………………

Kebele: ……………………………………… Community: ……………………………

Programme PSNP4 Subproject Name 01: Range Land management and Biophysical Soil and
Water Conservation

Activities: ___________________________________________________

DA. (Name): ……….…………………...

Step (i) Subprojects Ineligible as PSNP PW

Yes No

Subproject is in, or adjacent to, an internationally-disputed area

Subproject may involve the physical relocation of individuals or

households

Subproject incorporates a dam of more than 10 metres in height

Subproject located in a Priority Forest Area or natural habitat

Step (ii) a: Subprojects Requiring Special Attention

Yes No

Subproject likely to involve disposal of medical waste

Subproject likely to use pesticides or other agro-chemicals

Subproject incorporates a dam

Subproject might involve voluntary/ involuntary loss of assets, or access to

assets, such as land, pasture, water, public services, or crops, fruit trees, or
household infrastructure such as toilets or kitchens.

Is the Sub-project inside a Commune Centre or close enough to a CC to

have any potential direct or indirect impacts on it or on the people in a
CC ?

b: Subprojects of Environmental concern

 Yes No

Subproject located within National Park or other designated wildlife area

or buffer zone

Subproject located within a recognized Cultural Heritage site, or World

Heritage site

Subprojects incorporates a dam of >5m in height

Subproject involves abstraction form rivers draining into the Nile Basin

Step (iii) Subproject Screening

Potential for Adverse Impacts

01: Range Land management and Biophysical Soil and
Water Conservation None Lo Me Hig Unkno
w d h wn

Potential for landslides or erosion due to susceptible soils

Introduced plant/tree species invasion of native species

Biophysical SWC structures blocking movement of

people/livestock

Sensitive downstream ecosystems affected due to the subproject

interventions

Wildlife habitats or populations disturbed

Environmentally sensitive areas disturbed

Insufficient capacity to manage subproject

Insufficient capacity to prohibit or control open grazing

Insufficient capacity to manage new plantations/pastures

Other (specify):
 Mitigating Measures Required

Potential Impacts Mitigation Measure

Approved Unconditionally: Approved subject to Special Procedures and/or
Mitigating measures

Notify to REPA as Subproject of Environmental Concern: Rejected:

Screening conducted by (DA name):

Name………………..………. Position: …………………..Signature:………... Date:……

Screening supervised by:

Name………………..………. Position: …………………..Signature:………... Date:……

Environmental management and monitoring Plan

Prepare an environmental management and monitoring plan (EMMP) for all mitigation measures identified above. Indicate timing for
implementing each activity, duration of monitoring, responsible institutions, cost estimation, etc.

Mitigative measures (MM) Time of Responsible Issues to be Responsible Time of Estimated cost
implement body to monitored institutions monitorin to implement
ation implement to monitor g MM (Birr)
MM







Name Position/title Signature

<

<
<

Date submitted _________________