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 ____________________