IEE CHECKLIST for

Buildings with 4 to 10 Stories

INITIAL ENVIRONMENTAL EXAMINATION

(IEE) CHECKLIST
FOR BUILDINGS WITH 4 TO 10 STOREYS
INCLUDING BASEMENT FLOORS

1. GENERAL INFORMATION:

1.1 Project Name/Title ______________________________________________

1.2 Name of Project Proponent/ :_______________________________________

Contact Person/Designation :_______________________________________
Address :_______________________________________
(complete address street/sitio/ barangay, city/municipality, province)
Telephone/Fax No: :_______________________________________
E-mail :_______________________________________

1.3 Project Location :_______________________________________

(complete address street,sitio, barangay, city/municipality, province)

(Attach location map with important landmarks and access points indicated as Annex 1)

1.4. Project Objectives :

[ ] Proposed [ ] Existing [ ]Expansion
( ) Rehabilitation ( ) Area
( ) Demolition & Put up ( ) Additional facilities
Specify _________________________

Purpose : [] Office building

[] residential building
[] office/residential building
[] others: ________________________________

1.5 Total Cost (civil works and equipment): P _____________ (range)

Mode of Project Financing

œ Self-Financed œ Bank Loan

œ Government Financing œ Others

1.6 Project Ownership :

[ ] Single Proprietorship [ ] Corporation
[ ] Partnership/Joint Venture [ ] Cooperative
[ ] Others, please specify ___________________________

1.7 List of Owners (For Partnership/Corporation)

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_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

2. PROJECT DESCRIPTION

2.1 Project Area Coverage

Total Land Area to be developed ( sq. m / hectare) : ________________________

2.2 Land Ownership

 Ownership of the land by virtue of OCT/TCT # _______________________
 Stewardship of the land by virtue of ________________________________
 Lease of land by virtue of ________________________________________
 Pending application for __________________________________________
 Others, please specify ___________________________________________

(Please attach pertinent document)

2.3 General Land Classification

[ ] Public land [ ] Alienable and disposable

[ ] Private land

2.4 Project Facilities

(Attach complete lay-out/site development plan including expansion plan of the proposed
building)

Facility Area (sq. m )/ Capacity/ No.

2.5 Water Resources and Infrastructures

a. Water demand
Estimated daily water requirement of the proposed or existing project : _______ cu. M
per day

b. Water supply/sources
 Existing public water supply []
 Surface water
Volume of
Water Source Name of water Location Distance Mode of extraction
body (km) dev’t/ (cu. M/ day)

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distribution
1. Creek
2. Spring
3. Stream
4. River
1. Others,
specify
_____________
__

 Deep well

Water Source No. of Wells/ Location Depth Discharge Rate

Hand Pump/ (lps)
Tanks
1. Deep well
with manual
hand pumps
2. Deep well
with electric or
motor pump

 Rainwater
Collection and storage No. of tanks/reservoir Capacity
1. Collected in storage tanks
2. Collected in Reservoir

a. Water Treatment

If your water supply sources are surface water, deep well or rainwater, will there be
water treatment?
[ ] yes [ ] no

If yes, what type of water treatment?

[ ] chlorination [ ] filtration [ ] Others,specify :

_________________

2.6 Power Supply

Source of power: [ ] Local electric cooperative

[ ] Own generator capacity _____________
[ ] Others, specify _______________________________

2.7 Drainage System

(Attach drainage lay out plan as Annex)

Type of drainage available

a. Major roads [ ] Open canal [ ]closed/ underground drainage
[ ] none

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b. Other Roads [ ] Open canal [ ]closed/ underground drainage

[ ] none

Where does the drainage system drain?

[ ] Public drainage system [ ] Natural out fall/ water body, specify:

name of water body ______________
location ________________________
2.8 Sewage Disposal System
(Attach sewage design layout as Annex )
 Sewage system
[ ] Individual septic tank [ ] Communal septic tank
[ ] Centralize septic tank

 Sewage disposal
[ ] Discharge to an existing public sewerage system
[ ] Treated in a community disposal plant or communal septic tank
[ ] Treated in individual septic tanks with disposal by absorption field or leaching
pit
[ ] Others, please specify: _____________________________________

2.9 Solid Waste Collection and Disposal System

 Collection system
[ ] building/project maintained garbage collection system
[ ] integrated into municipal garbage collection system
[ ] others, specify: ______________________________

 Will there be waste sorting/ segregation prior to disposal? [ ] yes [ ] no

 Disposal system
[ ] open dumpsite outside of the project area
[ ] municipal/city landfill area
[ ] Others, specify: _______________________

location of the waste disposal site: ____________________________

2.10 Manpower and employment

(Attach listing of manpower requirement)

 How many people will be employed by the proposed project

During pre-construction/construction stage: ____________

During operation and maintenance stage: ____________

2.11 Project Schedule

(Attach schedule of development activities from pre-construction, construction and operation
phase)
3. DESCRIPTION OF EXISTING ENVIRONMENT

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Components/Parameters Yes No Remarks

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1.What is the general elevation of the

proposed building:
< 100 masl
100 to 300 masl
301 to 500 masl
501 to 1000 masl
1001 to 1500 masl
> 1500 masl

(To determine elevation, refer to the

topographic map where the elevation
per contour lines is indicated)
2. Slope and topography of the area
covered by the project

- Terrain is flat ( 0-3% slope)

- Gently sloping or undulating (3-8%
slope)
- Undulating to rolling ( 8 – 18% slope)
- Rolling to moderately steep ( 18- 30%
slope)
- Steeply rolling ( 30-50% slope)
- Very steep to mountainous
( >50%slope)
3. Are there areas in the site where there Cause of erosion:
are possible occurrence of soil erosion? [ ] heavy rains
[ ] unstable slopes
[ ] others, specify
_________

4. Has the area experienced any Period of flooding:

flooding during the wet season or _____________________
typhoon?
Causes of flooding:
[ ] low area
[ ] poor drainage
[ ] water-logged areas
5. Soil type of the area:
[ ] sandy soil
[ ] clayey soil
[ ] sandy clay loam soil

6. Air Conditions/Quality
[ ] good [ ] fair [ ] poor

7. Are there existing water bodies within If yes, indicate the name
1.5 km of the proposed building, e.g. and distance of the water
creeks or streams? body.

8. Is the ground water potable?

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9. Is the surface water

[ ] Not polluted
[ ] Polluted
[ ] highly polluted
10. What are the present uses of the
water body within or near the project
site?
[ ] bathing
[ ] washing
[ ] fishing
[ ] source of drinking water
[ ] recreation (swimming, boating, etc)
[ ] Others, specify
__________________________

11. Are there Critical Ecological System Type:

(Mangrove, Forestlands, etc.) within [ ] mangrove [ ] sanctuary
or near the area? [ ] forestland [ ] corals
[ ] aquifer
12. Will the proposed project be located in If yes, present result of the
a reclaimed area? soil stability study in Annex
13. Are there seismic hazards in the area,
i.e. faults (within 500m radius)?
14. Is the area prone to landslides? Indicate potential to
landslides
[ ] high [ ] medium [ ] low
15. Is there an access road going to the Type of access road
project site? (national, city, barangay)

___________________
___________________
___________________

16. What is the present land use of the Indicate the present land
area? use within:
[ ] prime agricultural land (productive)  50 m radius
[ ] prime agricultural land ( idle or  100 meter
abandoned) radius
[ ] grassland  200 meter
[ ] built-up (commercial, industrial) radius
[ ] built-up (residential)
[ ] orchard
[ ] marshland/mangrove
[ ] others, specify :
_______________

16. Does the site conform to the approved

land use plan of the city/municipality?
17. Does the land allocation and
alignment of the various utilities

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integrate with the existing networks

and projects outside of the boundaries
of the project site?
18. Are there existing structures or
developments around the project site?
If yes, please list them
down:
_____________________
_____________________
_____________________
_____________________

20. Are there public or private easements

across site?

21. Are there existing environmental Indicate if there are

problems within 500 m influence area incidence of the following:
[ ] water pollution
[ ] air pollution
[ ] noise pollution
[ ] soil erosion
[ ] flooding
[ ]Others specify:
___________________

22. Are there existing trees and other
types of vegetation in the site
23. Are there birds and other forms of
wildlife found in the area and which
has significant value
24. Are there fishery resources in the
water bodies near or within the site?
25. Are there existing settlement in the
proposed project site who will be
affected?
If yes provide examples:
If yes provide examples:
If yes provide examples:
If yes, indicate the number:
Households: _____
Legitimate landowners: _
Tenants: ____________
Squatters: ___________

26. What is the total population of the

barangay where the project will be
located __________

27. Average family size

28. What are the major sources of
livelihood?
[ ] farming [ ] fishing
[ ] vending/buy and sell
[ ] employment
[ ] Others, specify:
________________
_____________________________
_

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29. Are there local organizations in the Please give examples:

area? ___________________
___________________
___________________

Are there existing social infrastructures in [ ] schools

the barangay? [ ] communications
[ ] health centers
[ ] hospitals
[ ] churches/chapel
[]others,specify
_________
___________________
Are there oppositions to the project? Indicate reason for
opposition:
____________________
____________________
____________________

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4. IMPACT ASSESSMENT AND MITIGATION

Predicted Impacts Significance of Impacts** Mitigating/Enhancement

Measures
+/- D/In L/S R/I
A. Pre-Construction ands Construction Phase of the Project
A1.Increase in dust  Regular watering of
generation due to clearing, unpaved roads or exposed
civil works and earthmoving soils/ground
activities  Remove soil /mud from
tires of trucks and
equipment before leaving
the area.
 Hauling trucks should be
covered with canvass or
any equivalent materials
 Set-up temporary fence
around the construction
area.
A2. Top soil removal and loss  Stockpile the top soil in a
due earthmoving activities, safe place and use as final
transport, access road grading material or final
construction layer
 As soon as possible, rip-
rap or re-vegetate the
area
A3. Erosion from exposed  Conduct construction
cuts and landslides due to activities during dry
earthmoving and excavation season
activities  Avoid long exposure of
opened cuts
 Installation of barrier nets
A4. Sedimentation/siltation of  Set-up temporary silt
drainage or waterways from trap/ponds to prevent
unconfined stockpiles of soil siltation
and other materials  Proper stockpiling of spoils
(on flat areas and away
from drainage routes
 Spoils generated from civil
works be disposed as
filling materials

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A5. Pollution of nearby water  Set-up temporary disposal

body due to improper disposal mechanism within the
of construction wastes construction area and
properly dispose the
generated solid wastes.
 Set up proper and
adequate toilet facilities
 Strictly require the
contractor and its workers
to observe proper waste
disposal and proper
sanitation
A6. Loss of vegetation due to  Limit land clearing as
land clearing much as possible
 Provide temporary fencing
to vegetation that will be
retained
 Use of markers and
fences to direct heavy
equipment traffic in the
construction site and avoid
damage to plants
 Re-plant/ plant indigenous
tree species and
ornamental plants
A7. Disturbance or loss of  Re-establish or simulate
wildlife within the influence the habitat of affected
area due to noise and other wildlife in another suitable
construction activities area
 Schedule noisy
construction activities
during day time
 Undertake proper
maintenance of equipment
and use mufflers
A8. Noise generation that can  Schedule noisy
affect the nearby resident construction activities
during day time
 Undertake proper
maintenance of equipment
and use mufflers
A9. Generation of  Hiring priority shall be
employment given to qualified local
residents
A10. Conflicts in right of way  Conduct consultation and
settle agreements before
finalizing detailed design

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A11. Increased traffic and  Strict enforcement of

possible congestion traffic rules and
regulations
 Proponent should provide
traffic aid during peak
hours
A12. Increase in the  Strictly require the
incidence of crime and contractor and its workers
accidents to follow safety rules and
regulations in the
construction and in the
locality (in coordination
with local authorities)
B. Operation Phase of the Project
B1. Generation of domestic  Provision of an effective
effluents (at least 3-chamber septic
tank)
 Provision of adequate
wastewater treatment
facilities
B2. Generation of solid  Segregation of recyclable
wastes materials
 Proper collection and
disposal of solid wastes
 Proper housekeeping and
waste minimization
B3. Increased traffic and  Strict enforcement of
possible congestion as well as traffic rules and
increase risk of vehicular and regulations
vehicular related accidents  Placement of signage and
warnings in appropriate
places

Legend: (+) positive impact (-) negative impact

D direct impact In - Indirect impact
L - long term S short term
R - Reversible I Irreversible

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5. ENVIRONMENTAL MANAGEMENT PLAN

Project Impacts Mitigating Cost Responsible Guarantee

Phases Measures Person/Unit
Activities
(Indicate here (Indicate here
all impacts all mitigating
identified in measures
Section 4) identified in
Section 4)

6. PROPONENT’S COMMITMENTS

I/ We am/are committing to:

1. Comply with the existing environmental rules and regulations

2. Comply with all the mitigation and enhancement measures identified in impact
assessment and implement the environmental management plan
3. Organize and conduct information and education activities on environmental health,
safety and environment and other civic issues for the benefit of the employees,
contractors and workers
4. Others (to be prescribed by DENR – Regional Office)

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ACCOUNTABILITY STATEMENT

This is to certify that all the information and commitment in this Initial Environmental
Examination (IEE) Checklist are true, accurate and complete. Should I/we learn of any
information which would make the IEE more accurate, I/we shall bring the said information to
the appropriate EMB DENR Regional Office.

I/We hereby bind myself/ourselves jointly and solidarily for any penalties that may be
imposed from any misrepresentations or failure to state material information in the IEE.

In witness whereof, I/we hereby set our hands this ______ day of
_________________________ at ____________________________.

______________________
Project Proponent

______________________
Title/Designation

ACKNOWLEDGMENT

Before me this _____day of ________, _____at _________________ personally appeared

________________with Community Tax Certificate issued on ___________ at
_________________, in his/her capacity as _______________________of
___________________and acknowledged to me that this IEE Checklist is his voluntary act and
deed, and the voluntary act and deed of the entity he/she represents. |This document which
consists of __________ including the page on which this acknowledgement is written, is an
Initial Environmental Examination Report.

___________________________
Notary Public

Doc. No. ______

Page No. ______
Book No. ______
Series of _______

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SUPPORTING DOCUMENTS:

(Pertinent supporting documents should be completely complied/attached as

listed below)

i) Letter request []
ii) Locational Clearance []
iii) Site Development Plan []
(showing all project facilities)
iv) Colored pictures (panoramic view) []
(preferably with captions)
v) CENRO certification as to the land []
classification
vi) Proof of social acceptability
a) Barangay Resolution []
b) City/Municipal Resolution
vii) Topographic Map []
viii) Approved Sketch Plan and Vicinity Map []
within 500 meters influence area
ix) Photocopy of TCT []
x) Compliance of PD 984
Authority to Construct (A/C),
Permit to Operate (P/O)
- Gen Set Installation []
- STP/WTF (applicable only if[ ]
building accommodates more than
500 occupants or 100 rooms)
xi) Fees:
Filing Fee: P 310.00
Research Fee: 70.00
Processing Fee: 1,750.00
_________
Total: 2,130.00

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