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: _______________________________________________________
Contact Number/s
Landline : _______________________________________________________
Fax Number: _______________________________________________________

Generic IEE Checklist Report Form

 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)

Water Source

Generic IEE Checklist Report Form

 [ ] 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

 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
 Grassland þ Limit land clearing as much as possible
 Mangrove þ Provide temporary fencing for vegetation
 Wetland that will be retained
 Others, specify þ Promote restoration of damaged or
____________________ destroyed vegetation where possible (e.g.,
tree 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

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Stabilization of embankment with grasses ___________
or other soil cover
 Others, specify
____________

 Compliance with the DENR Administrative

Is the project site located in an area Order No. 2003-30 and DENR
identified by MGB/PAG-ASA/ Administrative Order No. 2000-28,
PHIVOLCS as hazard prone? Implementing Guidelines on Engineering
 Yes Geological and Geo-hazard Assessment
 No (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
 sandy-loam construction area þ Daily inspection for presence
 Others, specify þ Implement re-use and recycling of waste of mixed garbage in the
____________ materials facility
þ Implement proper segregation, collection þ Weekly inspection of waste
and disposal of domestic wastes in accumulated
designated areas  Others, specify
þ 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  Implement landscaping and other  Regular inspection of þ 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
 Others, specify zones
________________ þ Regularly monitor
presence/absence of
complaints from adjacent
property owners
WATER

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Increased siltation due Specify nearest/receiving water þ Set-up proper and adequate sanitary Regular (ocular) inspection of: þ Cost integrated in the
to project activities body: facilities  Drainage / canal systems construction/ operation cost
 Water quality ____________________________ þ 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
 0 to less than 0.5 km 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.)  BOD
If nearest/receiving water body is  Set up silt trap/stilling ponds to minimize  Total Coliform
fresh water, specify classification: downstream siltation  Color
 AA  Provision of three-chambered septic tank  Oil and Grease
 A for domestic sewage
 B  Provide ring canals around fuelling tanks/
 C motorpool/ maintenance areas
 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

Generic IEE Checklist Report Form

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

 Competition in water Size of population using receiving  Implement rainwater harvesting and similar þ Regularly monitor þ 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 þ Regular coordination with
 >5,000person disruption of traditional water uses concerned agencies
 Obtain Water Permit from NWRB þ Regularly monitor
Available/nearest water source.  Improve efficiency of water supply and occurrences of water
 Deepwell distribution system shortages
 Water district/LGU  Others, specify  Others, specify
 Surface water _____________________ ____________
 Others, specify
________________________

 Increased occurrence Is the project site located in an area  Use appropriate design for project facilities þ Regularly monitor þ Cost integrated in the
of flooding identified by MGB/PAG-ASA as  Implement appropriate drainage system presence/absence of construction/ operation cost
flood prone?  Regularly remove debris and other complaints
 Yes materials that may obstruct water flow þ Regular coordination with
 No  Use appropriate technology (e.g. raised concerned agencies
hand-pumps) to protect drinking water from þ Regularly monitor increased
flood contamination frequency of flooding
 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
pollution control device/s Regular (ocular) inspection of:
 Strictly enforce good housekeeping  Absence of white or black
practices smoke from vehicles,
 Control vehicle speed to lessen heavy equipment and
suspension of road dust generator
 Conduct water spraying to suppress dust  Presence of truck cover
sources and minimize discomfort to nearby during deliveries
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

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
trees
 Others, specify
______________________

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  >5,000person þ Promptly pay local taxes and other þ Regular coordination with
 Displacement of financial obligations LGU
Indigenous People Classification of host barangay: þ Regular coordination with LGU  Others, specify
 Enhanced employment  Urban  Prior consultation & coordination to _________________
and/or livelihood  Rural minimize disruption on daily domestic
opportunities activities & respect for IP rights and
 Reduced employment Available services within/near the cultural practices
and/or livelihood host barangay:  Ensure participation of IPs in consultations
opportunities  Schools (e.g. elementary, high and dialogues
 Increased revenues for school, college)  Provide appropriate traffic/warning signs,
LGU  Health facilities (e.g., clinics, lighting, etc
 Disruption/Competition hospitals, etc.)  Others, specify
in delivery of public  Peace and order (e.g., police ________________
services (e.g., outpost, brgy. Tanod, etc.)
education, peace and  Recreation and sports facilities
order, etc.)  Others, specify
 Enhanced delivery of _____________________
public services (e.g.,
education, peace and
order, etc.)
 Increase in traffic
volume and worsening
of traffic flow

 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

Generic IEE Checklist Report Form

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
_______________ þ Observe proper housekeeping LGU
 Provide on-site medical services for any þ Regular submission of reports
emergency. to concerned agency
 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