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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.
Total Project/Building
Footprint Area _______________________________________________________
(Area actually utilized)
Project Proponent: _______________________________________________________
_______________________________________________________
Office Address:
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
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 WGS 84 datum, otherwise specify datum
used).
Perimeter/Boundary points
Longitude Latitude
(based on OCT/TCT/etc)
Drainage system
(Please list facilities by module/grouping. Use additional sheets if needed)
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
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: ____________________________
Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh
1.4 MANPOWER
a. Construction Phase
Manpower Expertise/Skills Total
Requirement
b. Operation Phase
Manpower Expertise/Skills Total
Requirement
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
1.5 INDICATIVE PROJECT COST
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
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 ___________________
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);
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
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 (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
Provide receptacles / bins for solid wastes ___________________________
_______
Coordinate with the municipal / city waste
collectors
Engage third party company for waste
collection
Others, specify: ________________
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Impairment of visual Presence of visually significant Implement landscaping and other Regular inspection of Cost integrated in the
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 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 Water treatment facility (i.e.,
degradation workers to observe proper waste disposal grease trap, septic tank, etc.)
Others, specify Distance to nearest/receiving water
and proper sanitation
______________________ body: Strictly observe proper waste handling and Quarterly monitoring of the
following:
______ 0 to less than 0.5 km
disposal
0.5 to 1 km
Provision of wastewater treatment facility pH
More than 1 km
(e.g. septic tank, oil and water separator, TSS concentration
etc.)
BOD
If nearest/receiving water body is
Set up silt trap/stilling ponds to minimize
Total Coliform
downstream siltation
fresh water, specify classification:
Color
AA
Provision of three-chambered septic tank
for domestic sewage Oil and Grease
A
Provide ring canals around fuelling tanks/
B motorpool/ maintenance areas
C Others (Pls. specify): ___________
D
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Competition in water Size of population using receiving Implement rainwater harvesting and similar Regularly monitor Cost integrated in the
use surface water: measures as an alternative source of water presence/absence of construction/ operation cost
Depletion of water ≤ 1,000 persons Observe water conservation measures;
complaints
resources >1,000 and ≤ 5,000persons Careful selection of project site to avoid
Regular coordination with
>5,000person disruption of traditional water uses
concerned agencies
distribution system Others, specify
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 Regularly monitor Cost integrated in the
identified by MGB/PAGASA as
of flooding
flood prone? Implement appropriate drainage system
presence/absence of
complaints
construction/ operation cost
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
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 construction/ operation cost
0.5 to 1 km etc) complaints
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 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
_____________________________
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
PEOPLE
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 Regular coordination with
______________________ Observe proper housekeeping LGU
______________________
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Provide on-site medical services for any Regular submission of reports
emergency. to concerned agency
Participate in public awareness programs Others, specify
on health and safety _________________
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities
III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND
GENERIC GUIDELINES (if Applicable)
Provide description of the Abandonment activities, such as, dismantling and waste
disposal.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Organization Chart:
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities
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.
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.
__________________________
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 __________________________.
IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels,
Condominiums/Apartelles, and Storage Facilities