INITIAL ENVIRONMENTAL EXAMINATION (IEE)

CHECKLIST FOR
COMMUNITY-BASED FOREST MANAGEMENT PROJECTS

1. GENERAL INFORMATION:

1.1 Project Name/Title ______________________________________________

1.2 Name of PO :_______________________________________

Contact Person/Designation :_______________________________________
Address : _______________________________________
(Complete address street/sitio/ barangay, city/municipality,
province)
Telephone/Fax No: :_______________________________________
E-mail :_______________________________________
Number_______and date of registration of PO:__________________________
Type, number and date of Issuance of tenurial instrument:_________________
_______________________________________________________________

1.3 Project Location :_______________________________________

(Complete address street, sitio, barangay, city/municipality,
province)
Total area covered by tenurial instrument:______________________________

(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 :
________________________________________________

________________________________________________

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

(range)

Mode of Project Financing

[ ] Self-Financed [ ] Bank Loan
[ ] Government Financing [ ] 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 Land

Total land Area where the project will be located (square meters) :
________________________

2.2 Basis for land possession

 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

Land Use of the Project site [ ] Agricultural [ ] Industrial

Based on the proposed/approved [ ] Residential [ ] Tourism
Land Use Plan [ ] Commercial [ ] Institutional
[ ] Forest Land [ ] Open Space

Existing Land Use of the Project site [ ] Agricultural [ ] Industrial

[ ] Residential [ ] Tourism
[ ] Commercial [ ] Institutional
[ ] Forest Land [ ] Open Space

If Forest land what is the classification? [ ] Foreshore [ ] Mangrove

[ ] unclassified forest

3. Strategic Community Resource Management Plan

Community Resource Management Vision

Objectives:

1)
2)

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3)
4)
5)

Envisioned forestland uses:

Forest Land Uses Area(ha)

Protection forest ________

Old Growth forest ________
Steep (>50%) slopes ________
River banks ________
Erodible slopes ________
Sacred areas ________
Others ________
Production forest ________
Residual ________
Plantation ________
Pasture/grazing ________
Agriculture ________
Agroforestry/upland farms ________
Plantation crops ________
Settlements ________
Recreation ________
Grasslands/open areas ________
Lakes/bodies of water ________
Others ________
Project Components
( Attach complete lay-out/site development plan including expansion plan

Project Facilities

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

2.1 Water Utilities and Infrastructure:

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 a. Water demand
What is the estimated water requirements during Operation Phase?
_____________ in cu. meter per second

b. Water supply

Water Utilities (attach layout of water distribution system starting from the source)”
Source of Cooling Water for Refilling and Prime Mover if not electric”No. of
UnitsSource/MethodsCapacity (cu. meter)/Depth (m)Groundwater, dug well close with
motor pump (indicate depth/HP) with storage tankGroundwater, drilled well with motor
pump (indicate depth/HP) with storage tankSurface Water

Local Water District

Total volume of water extracted/utilized in cu. Meter/second (maximum)

If the source is groundwater,

[ ] With NWRB Permit or Certification (Attached Permit or Certification)
[ ] without NWRB Permit or Certification

2.2 Manpower and employment

Attach list of manpower requirement

How many people will be employed by the proposed project:

During pre-construction/construction stage: ______________

During operation and maintenance stage: ______________

2.3 Project Schedule

(Attach a schedule of development activities from pre-construction, construction
and operation phase)

4. DESCRIPTION OF ENVIRONMENTAL SETTINGS

1. Physical Environment: Components/ Parameters

Answer

Y
N

Is the terrain flat or level? (0 - 3% slope)

Is the terrain level to undulating? (3 – 8% slope)

Is the terrain undulating to rolling? (8 - 18% slope)

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Is the terrain rolling to moderately steep? (18 - 30% slope)

Is the terrain moderately steep to steeply mountainous? (30 - 50% slope)

Is the terrain very steeply mountainous? (above 50% slope)

Is the site near or with a forest reserve or a protected watershed area? If yes, how
near? ___________ meters

Does the site have limestone caverns or sinkholes in the bedrock?

Is the area erosion prone? If so, what is the status: slight, moderate or severe?

Are there existing natural hazards in the area, e.g., landslides, gullying, subsidence? If
yes, enumerate them
1. 5.
2. 6.
3. 7.
4. 8.

Are there natural drainage ways/creeks within the area draining towards communities
downstream?

Has the area experienced any flooding during wet season or typhoons? If YES, when
was the last time this was happened?____________________
What cause the flooding?
[ ] Water Logged area?
[ ] poor drainage?
[ ] low area/elevation

What is the soil type of the project area?

[ ] sandy
[ ] clayey
[ ] sandy loam

Are you beside or near the shoreline? If yes, how far? _____________ meters

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Are there water bodies found inside or near the project site? If yes, please enumerate
them.
1. 2.

Are there any existing structures or development around the project site? If YES,
please list them in the space below

Accessibility to the CBFM Area

Access to the site

___ existing trail/footpath ___ km
___ logging/dirt road ___ km
___ all-weather road ___ km
___ others (specify) ___ km

Access within the site

___ existing trail/footpath ___ km
___ logging/dirt road ___ km
___ all-weather road ___ km
___ others (specify) ___ km

What is the quality of water?

Fresh

Brackish

Attach photo of all water body within the project site (example, lake, creek, gully, river,
etc.)

2. Biological Environment (attached photos/drawings/maps whenever

appropriate)
Are you immediately adjacent to a natural ecosystem?

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yes

no

If yes, please check on the appropriate box/es:

Forest

Grassland

Coastal/Marine

Mangrove

Residential

Agricultural

Had you observe any wildlife in the area?

yes

no

If yes and you can identify them, please enumerate:

1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

Are there trees within the project site?

yes

no

If yes, please identify and enumerate:

1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

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Are there other vegetation within the project site?

yes

no

If yes, please identify and enumerate:

1. 2.

3. 4.

5. 6.

3. Socio-Economic Environment
3a. Existing Settlements within the project site

Category/Description
Number
What has happened to them?
(effects of project on them)

Total households affected

Total Population of the Barangay where the project is located?

Average Family Size

Source of their Livelihood

Agriculture ______
Employment ______
Logging ______
Collection of NTFP ______
Livestock ______
Cottage industry ______
Fishing ______
Mining ______
Others ______
____________ ______
____________ ______

Number of family/s to be relocated

Are there existing infrastructure in the Barangay? [ ] YES [ ] NO

If YES what are these structure? What is the distance from the project site?
Educational facilities in the barangay

______ Grades 1-4

______ Complete elementary
______ High School

If none, nearest school to the area

__________________________________________
Distance (km) ______________

3b. Proposed/ Profile of staff employed in the project/establishment

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Male
Female

During Pre/Construction Phase

During Operation

Total Number of Employee

How many of the proposed staff will come from the residents in the area?

Are there health facilities (clinic, etc.) within the project site?

yes

no

Are the required benefits under the Labor Code and other

yes

no

regulations will be enjoyed by the staff?

If yes, please enumerate them:
1. 2.

3. 4.

5. 6.

Are the local inhabitants

yes

no

benefited by the project? Pls. elaborate.

5. PROJECT IMPACTS

Components/
Answer

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Describe your mitigative/

Parameters
Yes
No
(Describe the impacts)
Enhancement measures

1. Pre-Operation Details

Is there any land clearing?

Total area to be cleared______________

[] Siltation of drainage’s or waterways from unconfined stockpiles of soil and

other materials.
[] topsoil removal, loss and soil erosion from earthmoving activities.
[] soil disturbance
and displacement from transport and hauling activities, access road/trail
construction, erosion from exposed cuts, etc.
[] set-up temporary silt traps/pond along waterbodies to prevent siltation.
[] proper stockpiling of spoils on flat areas and away from drainage areas.
[] avoid long exposure of open cuts.
[] installation of barrier nets.
[] provide site for spoil disposal.

Is there any vegetation clearing? Please provide details.

[] damages distinctive to existing vegetation from cutting, clearing or removal of weeds,

grasses and other types of vegetation during site preparation.
[] damages or disturbance to existing wildlife and vegetation from transport and hauling.
[] loss of vegetation.
[]decrease or disturbance to rare, endangered or threatened plants or animals species
present in the area.
[]disturbance or loss of habitants of birds and other wildlife species.
[] earthball small to medium-sized trees for transplanting in designated areas (above 20
cm. In diameter will not be cut).
[] replace every tree cut with not less than 10 nursery grown trees of the same species
of at least 1m high.
[] retention of matured trees species.
[] provide temporary fencing around important species to be retained.
[] use of markers and fences to direct heavy equipment traffic in the construction site
and avoid damaging important species

Is there any tree-cutting? Please provide details.

Number of trees to be cut________________

[] damages or disturbance to existing wildlife and vegetation from transport and hauling.
[] loss of vegetation.
[]decrease or disturbance to rare, endangered or threatened plants or animals species
present in the area.
[]disturbance or loss of habitants of birds and other wildlife species.
[] plant indigenous tree species and ornamental plants preferably native in the area.
[] avoid critical habitat areas and flora and fauna that maybe considered rare or
endangered by rerouting permanent structures.
[] re-established or simulate the habitat in other suitable areas.

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Is there any topsoil removal & replacement?

[] loss of top soil

[] soil erosion from earthmoving activities

[] stockpile the top soil and used as the final grading materials or final layer.
[] provide site for spoil disposal
[] installation of barrier nets proper stockpiling of spoils

Is there any excavation works and cut & fill activities?]

Ave, depth of excavation (m)

[] soil disturbance and displacement from transport and hauling activities, access
road/trail construction, erosion from exposed cuts.
[] increase in solid waste generation from excavation works.
[] increase in dust generation. Increase on noise generation.
[] stockpile the topsoil and used as final grading material.
[] conduct access road construction during dry season.
[] removed soil/mud from tires of trucks and equipment before proceeding to the
highway.

Is there any other earthmoving activities?

[] increase in dust generation from civil works, clearing and earthmoving activities.
[] increase in noise generation from site preparation/construction activities
[] regular watering of unpaved roads or exposed soils/grounds.
[] speed-up earthmoving activities.
[] hauling trucks should cover their loads with canvass or any equivalent materials.
[] set-up temporary fence around the construction site.
[] set-up temporary disposal site within the construction area and properly disposed to
generated solid waste at the existing dumpsite of the city/Municipality.
[] re-use as much construction spoils as possible in the construction activities.
[] set-up proper and adequate temporary toilet facilities.
[] conduct orientation of workers on proper waste disposal and proper sanitation.
[] schedule noisy construction activities during daytime.
[] undertake proper maintenance of equipment and use of muffler for certain
equipment.

Is there any structure that will be constructed in hazard prone areas?

[] hazards caused by sitting structures in geologically unstable areas.

[] undertake detailed geotechnical studies prior to construction to determine proper

siting of structures.
[] proper engineering design.

Is there any slope modification or ground levelling?

[] probable landslide.
[] siltation and/or erosion on the nearby waterbodies.

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[] use of benching method to stabilize the slope.
[] riprapping of cut areas .
[] stabilization of the slope through planting of vegetation.
[] provide proper drainage and silt traps along the slope.

Is there any increased traffic (vehicle) movement in the area?

[] increase in dust generation due to traffic movement.

[] increase in noise generation due to traffic movement.

[] regular watering of unpaved roads.

[] speed-up earth moving activities.
[] hauling truck should be covered with canvass or equivalent materials.
[] schedule hauling during day time
[] undertake proper maintenance of equipment and use of muffler for certain
equipment.

Is there any increased economic activity in the area?

[] increase in business and income opportunities for the local communities.

[] priority shall be given to purchasing some of the required building and food supplies
from the local business establishment.

Is there any increased availability of employment?

[] generation of employment
[] priority shall be given to the hiring of local workers.

Is there a rise in associated project activities?

[] rise in associated projects or economic activities in the surrounding areas.

[] interested community members can set-up a cooperative to corner the service
requirements of the contractor.

Is there any displacement of people in the area?

Did the displacement involve relocation of affected parties?

[] displacement of existing settlements in the area.

[] provide compensation based on negotiation and mutual agreement.
[] provide relocation site and alternative livelihood program, if necessary.

Is there a traffic problems during hauling and transport of produce to and from the site?

[] Traffic problems during hauling of construction materials.

[] schedule transport and hauling activities during non-peak hours when there is less or
no traffic.
[] site the entry and exit points in areas where there is no congestion or which are not
traffic gridlocks/checkpoints.

Is there a conflict in rights-of-way?

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[] conflict of right of way
[] conduct consultations with the concerned parties prior to finalizing any project lay-out
and design.
[] a mutually agreed terms or conditions of settlement which may be in the forms of
compensation.
[] compensation of affected household based on mutually agreed upon packages.
[] provisions of relocation sites.

Components/
Answer

Describe your mitigative/

Parameters
Yes
No
(Describe the impacts)
enhancement measures

2. Operations and Maintenance Phase

Is there any solid waste generation? Please specify volume generated

[] increase in solid waste which may cause air and water pollution of nearby
waterbodies and affect water quality.
[] provide a regular collection and disposal system.

Will there be reduced infiltration rate due to impermeable structures over the ground?

Is there an increase in surface run-off to other areas?

Is there reduce surface infiltration rates, which may decrease recharge of water table?

[] improved drainage and water system which can promote a more efficient use of water
supply.
[] increased surface run-off which may result to flooding or flashfloods in the area.
[] reduced surface infiltration rates which may decrease recharges of the water table.
[] provide adequate and appropriate drainage system, e.g. perimeter drainage,
interceptor.
[] conduct regular inspection and proper maintenance of both drainage and water
systems.
[] conduct regular cleaning of drain inlets.
[] provide adequate open spaces and greenbelts within project site.

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Will there be a safety risk in the area?

[] fire
[] explosion
[] traffic
[] accident
[] prepare and implement emergency response plan.
[] conducts risk assessment and prepare risk management.
[] orient workers on the emergency response plan to include individual responsibilities.
[] other, pls. Specify

Is there any hazardous waste (Used Oil, etc.) generated?

How do you dispose this?

[] contamination of the nearby waterbodies.

[] contamination of ground water

[] provide treatment facility prior to its disposal

[] provide containment pond.

Is there an increase in traffic (vehicle) movement in the area?

[] traffic and congestion

[] provide proper setting of entrance and exits to and from the site to avoid traffic
gridlock
[] provide adequate parking space within the project site.
[] provide adequate width of access road networks.

Is there an increase in economic activity in the area?

Is there an increase in economic opportunities?

[] rise in associated projects

[] strict implementation of land use plan

Is there an increase or decrease in land values?

[] increase of land values.

[]decrease in land values.
[] strict implementation of land use plan.

Is there an increase availability of employment?

[] increase in individual income

[] increase in family income
[] increase in local tax collection
[] priority shall be given to local residence for hiring.

Is there a land use changes which will affect habitat of birds and wildlife

[] changes in land use which will affect habitat of birds and wildlife.

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[] all open space and pathways should be planted with ornamental and indigenous tree
species that will attract birds and other wildlife.

Is there damages or disturbance of aquatic habitat from solid waste and sewage
pollution?

[] damage and disturbance to aquatic habitat cause by solid waste and sewage
pollution
[] provide treatment facility.
[] conduct regular monitoring.

Is there an increase in noise level in the area?

[] increase in noise generation during operation.

[] undertake proper maintenance of equipment.
[] provide noise reduction facility.

Is there any increase in air emission/dust generation in the area?

[] increase during operation

[] provide appropriate air pollution control equipment
[] provide gas mask among the workers

Components/
Answer

Describe your mitigative/

Parameters
Yes
No
(Describe the impacts)
enhancement measures

3. Abandonment and Rehabilitation Phase

Will any of the facilities be abandoned or demolished at the end of project life?

[] generation of the solid waste

[] proper disposal of solid waste.
[] building structure will be turn over to the LGU.

Will there be an abandonment plan?

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Others, please specify

PROPONENT’s COMMITMENT

I/We am/are committing to …

Comply with existing environmental rules and regulations, guidelines and criteria?

Participate or support multi-partite monitoring efforts?

Comply with all mitigation and enhancement measures that have been identified in the
report.

Undertake, comply with the risk management formulated for the project.

Observed proper waste management practice by providing adequate garbage

receptacles in strategic points and observing proper disposal of the same.

Maintain the cleanliness of the general surroundings?

Extend social benefits to the community?

Undertake risk assessment upon receipt of the ECC and formulate risk
management/emergency response plan to minimize risk associated with the project.

Properly brief and orient employees about the ECC conditions, commitment and
agreement made about the project.

Others, Please specify

I. ATTACHMENTS

1. Government Permits and Clearances (attach photocopies of documents)

Permits/Clearances
Attached?

Location Map/Vicinity Map

Endorsement of Barangay and Municipal/City

Photocopy of TCT/OCT/ TD

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SEC Registration and Article of Incorporation

Photo Copy of Lease Contract

Locational Clearance for HLURB

CDA Registration

ACCOUNTABILITY STATEMENT

This is to certify that all the information and commitments in this Initial
Environmental Examination (IEE) Report are true, accurate, and complete. Should I/we
learn of any information which would make the IEE inaccurate, I/we shall bring said
information to the attention of the Environmental Management Bureau Regional Office.

I/We hereby bind myself/ourselves jointly and solidarily for any penalties that
may be imposed arising 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 or Designation

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ACKNOWLEDGMENT

BEFORE ME this ______ day of ________________, 19 _____ at

___________________________, personally appeared
____________________________________ (Place)
( Name)
with Community Tax Certificate No. ____________________ issued on
________________ at __________________, in his/her capacity as
_____________________________(position) of ( name of
establishment)_______________________________________________ and
acknowledge to me that this IEE is his voluntary act and deed, and the voluntary act and
deed of the entity he/she represents. This document, which consists of ______________
pages, including the page on which this acknowledgement is written, is an Initial
Environmental Examination Report Checklist.
Witness my hand and seal on the place and date above written.

_____________________________
Notary Public
Doc. No. _______
Page No. _______
Book No. _______
Series of 1999____

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