ROAD AND BRIDGE PROJECTS

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST

For

________________________________________________________
Project Name or Title

This IEE Checklist Report shall be used for proposed ROAD AND BRIDGE PROJECTS
to be located within Environmentally Critical Areas (ECA).

Please check applicable project category:

Project Size Corresponding Project

 Projects
Parameter Size/Threshold
Bridges and viaducts, new
length ≥ 80 m but < 10.0 km
construction
length with no
Roads, new construction, ≥ 2 km but < 20.0 km,
critical slope, OR
widening OR
length with
(including RO-RO facilities) ≥ 2 km but < 10.0 km
critical slope
Elevated roads, Regardless of length and
flyover/cloverleaf/ interchanges width
Tunnels and sub-grade roads
length < 1.0 km
and railways
Pedestrian passages All underpass projects

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 duly-accomplished forms with complete attachments

Misleading or erroneous answers are basis for legal actions and/or denial of ECC issuance.

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 PROJECT FACT SHEET

Project Name: _______________________________________________________

Project Location: _______________________________________________________

Road/Bridge Width : ______________________________________________________

Road/Bridge Length : ______________________________________________________

Project Proponent: _______________________________________________________

_______________________________________________________
Office Address:
Contact Person: _______________________________________________________
Designation: _______________________________________________________
Contact Information
Telephone Number: _________________________________________
Fax Number: _________________________________________
Mobile Number: _________________________________________
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 including alignment and design.

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)

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 1.2 PROJECT COMPONENTS

Facilities Length / Specification/Description/Remarks

Area
(meters)
1. Road

2. Intersections

3. Bridge/s

4. Access roads/Ramp

5. Drainage facilities
(i.e. Reinforced Concrete Box Culverts
(RCBC);Reinforced Concrete Pipe
Culverts (RCPC), others)
6. Associated facilities (i.e. Guardrails,
Traffic signs, etc.)

7. Solid waste management facility

8. Others, specify
_______________________

(Use additional sheets if needed)

1.3 UTILITIES/REQUIREMENTS (Construction Phase):

Utilities Source Estimated

Demand/Consumption
Power/Electricity
KWh
(Total)
Power/Electricity
(From Renewable Energy KWh
Sources)
Water
(Total) 3
m /day
(Fill-up table below if water is not
obtained from the local water utility)
Water
(Rainwater Collection 3
m /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)

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Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh

3
Water m /day

1.4 MANPOWER

a. Construction Phase
Manpower Expertise/Skills Total
Requirement

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

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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  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:  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 to vegetation
that will be retained
 Wetland  Promote restoration of damaged or
 Others, specify destroyed vegetation where possible (e.g.,
____________________ road side tree planting);

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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,
trees or other soil cover /construction of
rip-rap
 Others, specify
Is the project site located in an area ____________
identified by MGB/PAG-ASA/
PHIVOLCS as hazard prone?  Compliance with the DENR Administrative
 Yes Order No. 2003-30 and DENR
Administrative Order No. 2000-28,
 No Implementing Guidelines on Engineering
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
____________________
 Implement proper segregation, collection  Weekly inspection of waste
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

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
collectors
 Engage third party company for waste
collection
 Others, specify
________________

 Encroachment into Is the project area near protected  Obtain appropriate permits/clearances  Regular coordination with  Cost integrated in the
protected areas or areas or ecologically-sensitive from concerned agencies concerned agencies construction/ operation cost
areas?
ecologically-sensitive  Provide adequate buffer
areas  Yes
 Others, specify
 No ________________

 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  Sanitation facilities
degradation Distance to nearest/receiving water workers to observe proper waste disposal
 Others, specify body: and proper sanitation Regular (ocular) inspection of
__________________  0 to less than 0.5 km
 Strictly observe proper waste handling and water body for:

 0.5 to 1 km
disposal  Turbidity and/or silted
 Set up silt trap(Gabions, Fascines)/settling condition
 More than 1 km ponds to minimize downstream siltation  Floating wastes or debris
If nearest/receiving water body is
 Others, specify
___________
fresh water, specify classification:

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 AA
 A
 B
 C
 D

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

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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  Cost integrated in the
use surface water: measures as an alternative source of water  Regularly monitor for construction/ operation cost
 Depletion of water  ≤ 1,000 persons  Observe water conservation measures presence/absence of
resources  >1,000 and ≤ 5,000persons  Others, specify
complaints

 >5,000person ____________________
 Regular coordination with
concerned agencies
Available/nearest water source.  Regularly monitor for
occurrences of water
 Deepwell shortages
 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 for  Cost integrated in the
identified by MGB/PAG-ASA as
of flooding
flood prone?  Implement appropriate drainage system
presence/absence of
complaints
construction/ operation cost

 Yes  Regularly remove debris and other

 Regular coordination with
materials that may obstruct water flow
 No concerned agencies
 Others, specify  Regularly monitor for
______________________ increased frequency of
flooding
 Others, specify
_________________

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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 for  Cost integrated in the
 0 to less than 0.5 km sources (e.g. vehicles, generator, etc) presence/absence of construction/ operation cost
 0.5 to 1 km  Install when applicable, the appropriate air
complaints

 More than 1 km pollution control device/s

Regular (ocular) inspection of:
 Strictly enforce good housekeeping
 Absence of white or black
practices
smoke from vehicles, heavy
 Control vehicle speed to lessen equipment, generator, etc.
suspension of road dust
 Presence of truck cover
 Conduct water spraying to suppress dust during deliveries
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 for  Cost integrated in the
generation  0 to less than 0.5 km sources (e.g. vehicles, generator, etc) presence/absence of construction/ operation cost
 0.5 to 1 km  Install when applicable, the appropriate
complaints

 More than 1 km noise control device/s (e.g., mufflers,  Regular monitoring of buffer
silencer, sound barriers, etc.) zones
 Implement appropriate operating hours
 Provide adequate buffer and/or planting of
trees
 Others, specify
____________________________

PEOPLE

 Displacement of Size of population of host barangay:  Provide relocation/disturbance  Regularly monitor for  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
 Prioritize local residents for employment complaints
vicinity
 Promptly pay local taxes and other  Regular coordination with
 Displacement of  >5,000person financial obligations LGU

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Indigenous People  Regular coordination with LGU  Others, specify
 Enhanced employment Classification of host barangay:
 Prior consultation & coordination to
_________________
and/or livelihood  Urban minimize disruption on daily domestic
opportunities  Rural activities & respect for IP rights and
 Reduced employment cultural practices
and/or livelihood Available services within/near the  Ensure participation of IPs in
opportunities host barangay: consultations and dialogues
 Increased revenues for  Schools (e.g. elementary, high  Provide appropriate traffic/warning
LGU school, college) signs, lighting, etc
 Disruption/Competition  Health facilities (e.g., clinics,  Others, specify
in delivery of public hospitals, etc.) _________________
services (e.g.,
education, peace and
 Peace and order (e.g., police
outpost, brgy. Tanod, etc.)
order, etc.)
 Enhanced delivery of
 Recreation and sports facilities
public services (e.g.,  Others, specify
education, peace and ________________
order, etc.)

 Increase in traffic
volume and worsening
of traffic flow

 Impacts on community  Regular coordination with LGU  Regularly monitor for  Cost integrated in the
health and safety  Provide appropriate warning signs, lighting presence/absence of construction/ operation cost
 Others, specify and barricades, whenever practicable complaints
__________________  Observe proper housekeeping  Regular coordination with
LGU
 Provide on-site medical services for any
emergency.  Regularly monitor submission
of reports to concerned
 Participate in public awareness programs agency
on health and safety
 Others, specify
 Implement appropriate safety programs for _________________
both community and workers
 Others, specify
__________________________

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III. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION

Organization Chart:

12
Attach design/plan/alignment of project (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.

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.

____________________
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 ____________________

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