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 to be located within Environmentally Critical Areas (ECA) where a
customized IEE Checklist Report Form has not yet been developed but are required IEE
Checklist Report Form or IEE Report per existing guidelines

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: _______________________________________________________

Generic IEE Checklist Report Form

 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

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

Generic IEE Checklist Report Form

 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 Requirement Expertise/Skills Total

b. Operation Phase
Manpower Requirement Expertise/Skills Total

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

Generic IEE Checklist Report Form

 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, 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: 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
clearing  Marshland
Permit
þ Limit land clearing as much as possible
 Grassland
þ Provide temporary fencing for vegetation
 Mangrove that will be retained
 Wetland þ Promote restoration of damaged or

Generic IEE Checklist Report Form

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
 Others, specify destroyed vegetation where possible (e.g.,
tree planting);
____________________
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, specify
 Stabilization of embankment with grasses ___________
or other soil cover
 Others, specify
____________

Is the project site located in an area
identified by MGB/PAG-ASA/
PHIVOLCS as hazard prone?
 Yes
 No
 Compliance with the DENR Administrative
Order No. 2003-30 and DENR
Administrative Order No. 2000-28,
Implementing Guidelines on Engineering
Geological and Geo-hazard Assessment
(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
þ Daily inspection for presence
 sandy-loam
construction area
of mixed garbage in the
þ Implement re-use and recycling of waste
 Others, specify materials
facility
____________
þ Implement proper segregation, collection
þ Weekly inspection of waste
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

Generic IEE Checklist Report Form

Possible Environmental/
Social Impacts
 Impairment of visual
aesthetics
 Devaluation of land
values
WATER
 Increased siltation due
to project activities
 Water quality
degradation
 Others, specify
___________________
Generic IEE Checklist Report Form
Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Implementation
 Engage third party company for waste
collection
 Others, specify ________________
Presence of visually significant
landforms/landscape/structures?
 Implement landscaping and other  Regular inspection of þ Cost integrated in the
beautification measures landscaping and other construction/ operation cost
 Yes
 Provide adequate buffer beautification activities
 No
 Compensate adjacent property owners
 Regular monitoring of buffer
zones
 Others, specify
þ Regularly monitor
________________ presence/absence of
complaints from adjacent
property owners
Specify nearest/receiving water þ Set-up proper and adequate sanitary Regular (ocular) inspection of: þ Cost integrated in the
body:
____________________________
facilities  Drainage / canal systems construction/ operation cost
þ Strictly require the contractor and its  Water treatment facility (i.e.,
Distance to nearest/receiving water workers to observe proper waste disposal grease trap, septic tank, etc.)
and proper sanitation
body:
 0 to less than 0.5 km  Strictly observe proper waste handling and Quarterly monitoring of the
disposal following:
 0.5 to 1 km
þ Provision of wastewater treatment facility  pH
 More than 1 km (e.g. septic tank, oil and water separator,  TSS concentration
etc.)
If nearest/receiving water body is
 Set up silt trap/stilling ponds to minimize
 BOD
fresh water, specify classification:
downstream siltation  Total Coliform
 AA
 Provision of three-chambered septic tank  Color
 A for domestic sewage  Oil and Grease
 B  Provide ring canals around fuelling tanks/
 C motorpool/ maintenance areas
 D  Others, specify
___________
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

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

 Competition in water Size of population using receiving

surface water:
 Implement rainwater harvesting and similar þ Regularly monitor þ Cost integrated in the
use measures as an alternative source of water presence/absence of construction/ operation cost
 Depletion of water
 ≤ 1,000 persons
 Observe water conservation measures;
complaints
 þ 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
þ Regularly monitor
Available/nearest water source.
 Obtain Water Permit from NWRB occurrences of water
 Deepwell
 Improve efficiency of water supply and shortages
distribution system  Others, specify
 Water district/LGU
 Others, specify ____________
 Surface water _____________________
 Others, specify
________________________

 Increased occurrence Is the project site located in an area

identified by MGB/PAG-ASA as
 Use appropriate design for project facilities þ Regularly monitor þ Cost integrated in the
of flooding
flood prone?  Implement appropriate drainage system
presence/absence of
complaints
construction/ operation cost

 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 _________________
_____________________

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

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
 0.5 to 1 km etc) complaints

 More than 1 km
 Install when applicable, the appropriate air
Regular (ocular) inspection of:
pollution control device/s
 Strictly enforce good housekeeping
 Absence of white or black
smoke from vehicles,
practices heavy equipment and
 Control vehicle speed to lessen generator
suspension of road dust  Presence of truck cover
 Conduct water spraying to suppress dust during deliveries
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
 0.5 to 1 km etc) complaints

 More than 1 km
 Install when applicable, the appropriate  Regular monitoring of buffer
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

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
______________________

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
site and within its  >1,000 and ≤ 5,000persons þ Prioritize local residents for employment complaints
vicinity
þ þ Regular coordination with
 Displacement of
 >5,000person Promptly pay local taxes and other
LGU
financial obligations
Indigenous People
Classification of host barangay: þ Regular coordination with LGU  Others, specify
 Enhanced employment
 Urban  Prior consultation & coordination to
_________________
and/or livelihood
opportunities  Rural minimize disruption on daily domestic
activities & respect for IP rights and
 Reduced employment
Available services within/near the cultural practices
and/or livelihood
opportunities
host barangay:  Ensure participation of IPs in consultations

 Increased revenues for

 Schools (e.g. elementary, high and dialogues

LGU
school, college)  Provide appropriate traffic/warning signs,

 Disruption/Competition
 Health facilities (e.g., clinics, lighting, etc

in delivery of public
hospitals, etc.)  Others, specify
services (e.g.,  Peace and order (e.g., police ________________
education, peace and outpost, brgy. Tanod, etc.)
order, etc.)  Recreation and sports facilities
 Enhanced delivery of  Others, specify
public services (e.g., _____________________
education, peace and
order, etc.)
 Increase in traffic
volume and worsening
of traffic flow

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 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
_______________ þ Observe proper housekeeping LGU

 Provide on-site medical services for any

þ Regular submission of reports
to concerned agency
emergency.
 Participate in public awareness programs
 Others, specify
_________________
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
______________________

Generic IEE Checklist Report Form

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:

Generic IEE Checklist Report Form

Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)

Generic IEE Checklist Report Form

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

Generic IEE Checklist Report Form

 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 to 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 ____________________

Generic IEE Checklist Report Form