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)
Annual Production Capacity: _______________________________________________________
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
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
See attached vicinity map/s and photographs of the project site and site development/layout plan.
Geographic coordinates of the project area (Preferably use PRS 92 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
(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)
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
Consistency with land Current land use w/in 1km radius See attached proof of compatibility with land
use (as per zoning ordinance): 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: Compliance with conditions of DENR/LGU Annual inspection of area Cost integrated in the
due to vegetation Forestland SLUP, Tree Cutting Permit, ROW, PCA Permit replanted/ revegetated construction /operation cost
clearing Marshland Limit land clearing as much as possible
Grassland
Provide temporary fencing for vegetation
Mangrove
that will be retained
Wetland
Others, specify Promote restoration of damaged or
____________________ destroyed vegetation where possible (e.g., tree
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
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
steep (>18%) topsoil set aside for later use and allow Regular inspection for new ____________
Soil Erosion 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 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
waste disposal
sandy Waste Management Plan (ESWMP) waste/recycling bins for
segregation
construction /operation cost
clay
sandy-loam Set-up temporary fence around the Daily inspection for presence
construction area
Others, specify
of mixed garbage in the facility
____________ Implement re-use and recycling of waste Weekly inspection of waste
materials accumulated
Implement proper segregation, collection
and disposal of domestic wastes in designated Others, specify
areas _____________
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
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
landforms/landscape/structures?
Implement landscaping and other Regular inspection of Cost integrated in the
construction/ operation cost
aesthetics beautification measures landscaping and other
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 Specify nearest/receiving water Set-up proper and adequate sanitary Regular (ocular) inspection of: Cost integrated in the
to project activities body:
____________________________
facilities Drainage / canal systems construction/ operation cost
Water quality Strictly require the contractor and its workers Water treatment facility (i.e.,
degradation Distance to nearest/receiving water to observe proper waste disposal and proper grease trap, septic tank, etc.)
Others, specify body: sanitation
Quarterly monitoring of the
___________________ 0 to less than 0.5 km
Strictly observe proper waste handling and following:
0.5 to 1 km disposal pH
More than 1 km TSS concentration
Provision of wastewater treatment facility
If nearest/receiving water body is (e.g. septic tank, oil and water separator, etc.) BOD
fresh water, specify classification: Set up silt trap/stilling ponds to minimize Total Coliform
AA downstream siltation Color
A Provision of three-chambered septic tank Oil and Grease
B
for domestic sewage
C
Provide ring canals around fuelling tanks/
motorpool/ maintenance areas
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
D Others, specify
___________
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/ 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 Regularly monitor
presence/absence of complaints
Cost integrated in the
construction/ operation cost
use measures as an alternative source of water
Depletion of water ≤ 1,000 persons Observe water conservation measures; 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
Regularly monitor occurrences
Available/nearest water source.
Obtain Water Permit from NWRB
of water shortages
Deepwell
Improve efficiency of water supply and
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/PAGASA as
Use appropriate design for project facilities Regularly monitor
presence/absence of complaints
Cost integrated in the
construction/ operation cost
of flooding
flood prone? Implement appropriate drainage system
Yes Regularly remove debris and other Regular coordination with
materials that may obstruct water flow concerned agencies
No
Use appropriate technology (e.g. raised
Regularly monitor increased
hand-pumps) to protect drinking water from
flood contamination frequency of flooding
Others, specify
Others, specify
_____________________
_________________
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 Regularly monitor Cost integrated in the
0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of complaints construction/ operation cost
0.5 to 1 km etc)
Regular (ocular) inspection of:
More than 1 km Install when applicable, the appropriate air
Absence of white or black
pollution control device/s
smoke from vehicles,
Strictly enforce good housekeeping heavy equipment and
practices generator
Control vehicle speed to lessen Presence of truck cover
suspension of road dust 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 Regularly monitor Cost integrated in the
generation 0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of complaints construction/ operation cost
0.5 to 1 km etc)
More than 1 km Install when applicable, the appropriate Regular monitoring of buffer
zones
noise control device/s (e.g., mufflers,
silencer, sound barriers, etc.)
Implement appropriate operating hours
Provide adequate buffer and/or planting of
trees
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Others, specify
______________________
PEOPLE
Displacement of Provide relocation/disturbance Regularly monitor
presence/absence of complaints
Cost integrated in the
construction/ operation cost
residents in the project compensation packages
site and within its Prioritize local residents for employment
vicinity Size of population of host barangay: Regular coordination with LGU
Displacement of ≤ 1,000 persons Promptly pay local taxes and other
Indigenous People >1,000 and ≤ 5,000persons
financial obligations Others, specify
_________________
Enhanced employment >5,000person Regular coordination with LGU
and/or livelihood
opportunities Classification of host barangay:
Prior consultation & coordination to
Reduced employment Urban minimize disruption on daily domestic
and/or livelihood
opportunities
Rural activities & respect for IP rights and
cultural practices
Increased revenues for Available services within/near the Ensure participation of IPs in consultations
LGU host barangay: and dialogues
Disruption/Competition Schools (e.g. elementary, high Provide appropriate traffic/warning signs,
in delivery of public school, college) lighting, etc
services (e.g.,
education, peace and
Health facilities (e.g., clinics, Others, specify
hospitals, etc.) ________________
order, etc.)
Enhanced delivery of
Peace and order (e.g., police
outpost, brgy. Tanod, etc.)
public services (e.g.,
education, peace and Recreation and sports facilities
order, etc.) Others, specify
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 Presence/Absence of Cost integrated in the
health and safety Provide appropriate warning signs, lighting complaints construction/ operation cost
Others, specify and barricades, whenever practicable
Observe proper housekeeping Regular coordination with
_______________ LGU
Provide on-site medical services for any
emergency. Regular submission of reports
Participate in public awareness programs to concerned agency
on health and safety
Implement appropriate safety programs for Others, specify
both community and workers _________________
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 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 ____________________
