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This IEE Checklist Report shall be used for proposed WATER SUPPLY PROJECTs to be located
within Environmentally Critical Areas (ECA).
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 (a) the appropriate boxes □ or parenthesis ( ). Boxes
with check marks(;) are automatically required. Use additional sheets if necessary
and indicate this in the appropriate space.
Misleading or erroneous answers are basis for legal actions and/or denial of ECC issuance.
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Total Project Land Area:
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 - GPS setting, otherwise
specify datum used).
Perimeter/Boundary points
Longitude Latitude
(based on OCT/TCT/etc)
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1.2 PROJECT COMPONENTS
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Water Source
[ ] ground water [ ] well [ ] spring [ ] others: ____________________________
Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh
Water m3/day
1.4 MANPOWER
a. Construction Phase
Manpower Expertise/Skills Total
Requirement
b. Operation Phase
Manpower Expertise/Skills Total
Requirement
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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
(as per zoning ordinance):
; See attached proof of compatibility with
use land use
Residential
Commercial/ Institutional
Industrial
Agricultural/ Recreational
Protected Areas
Others, specify
____________
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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, 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/
Compliance with the DENR Administrative
PHIVOLCS as hazard prone? Order No. 2003-30 and DENR
Yes Administrative Order No. 2000-28,
Implementing Guidelines on Engineering
No Geological and Geo-hazard Assessment
(EGGA).
; 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
; Implement re-use and recycling of waste of mixed garbage in the
Others, specify
materials facility
________________ ; Weekly inspection of waste
; Implement proper segregation, collection
and disposal of domestic wastes in accumulated
designated areas
Others, specify
Implement proper collection, labeling and ___________
storage of hazardous waste
; Provide receptacles / bins for solid wastes
Coordinate with the municipal / city waste
collectors
Engage third party company for waste
collection
Others, specify
________________
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Impairment of Presence of visually significant
landforms/landscape/structures?
Implement landscaping and other
Regular inspection of ; Cost integrated in the
visual aesthetics 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 Distance to nearest/receiving water workers to observe proper waste disposal grease trap, septic tank, etc.)
and proper sanitation
Others, specify body:
__________
0 to less than 0.5 km
; Strictly observe proper waste handling and
disposal Quarterly monitoring of the
0.5 to 1 km
Provision of wastewater treatment facility
following:
More than 1 km
Set up silt trap/stilling ponds to minimize
pH
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Increased occurrence Is the project site located in an area
identified by MGB/PAG-ASA as
Use appropriate design for project facilities ; Regularly monitor ; Cost integrated in the
presence/absence of construction/ operation cost
of flooding
flood prone?
Implement appropriate drainage system
complaints
Yes
Regularly remove debris and other
; Regular coordination with
materials that may obstruct water flow
No concerned agencies
Use appropriate technology (e.g. raised ; 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 ; 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
complaints
0.5 to 1 km etc)
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
generator, etc.
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 construction/ operation cost
complaints
0.5 to 1 km etc)
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
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
PEOPLE
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Impacts on community ; Regular coordination with LGU ; Regularly monitor ; Cost integrated in the
health and safety
Provide appropriate warning signs, lighting presence/absence of
complaints
construction/ operation cost
Others, specify and barricades, whenever practicable
__________ ; Observe proper housekeeping ; Regular coordination with
LGU
Provide on-site medical services for any
; Regularly monitor
emergency.
submission of reports to
Participate in public awareness programs concerned agency
on health and safety
Others, specify
Implement appropriate safety programs for ______________
both community and workers
; Strictly comply with fire, safety and similar
regulatory requirements
Strictly comply with requirements of RA
6969
Others, specify
____________________
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III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND
GENERIC GUIDELINES (if Applicable)
Organization Chart:
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Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)
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Process Flow
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Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)
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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)
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