FASTFOOD PROJECT

Initial Environmental Examination ( IEE ) Report

For

( Project Name or Title )

Below is the IEE Report checklist for Fastfood project proponents. Read the questions carefully
before answering in the space provided. Use additional sheets, if necessary, and indicate this in
the appropriate space.

Misleading or erroneous answers shall be used as basis for legal action and/or denial of
ECC.

PROJECT LOCATION :
_________________________________________________________________
(no., street, barangay, city/municipality, province)

GEOGRAPHIC COORDINATES :
_________________________________________________________
[attach location map as Annex 1 ]

NAME OF PROPONENT/OWNER :
_______________________________________________________
NAME OF CONTACT PERSON :
_________________________________________________________
ADDRESS :
___________________________________________________________________________
( no., street, barangay, city/municipality, province )
TELEPHONE NO. :
_____________________________________________________________________
FACSIMILE NO. :
______________________________________________________________________
E-MAIL or ADDRESS :
__________________________________________________________________

A. GENERAL INFORMATION
1. Project ownership

[ ] Single Proprietorship
[ ] Partnership
[ ] Corporation

[attach supporting documents as annex 2]

2. List of owners (for partnership/corporation, list top 3 partners/ shareholders with
largest holdings)

NAME/POSITION CITIZENSHIP ADDRESS % SHARE / HOLDING

3. Capitalization & Project Cost

Capitalization : ___________________________________________________________
Project Cost :
Proposed Date of Start of the Project :
Mode of financing : [ ] in – house [ ] bank [ ] others
_____________________________

4. land
Total land area : __________________________ sq. m.
Right over land : [ ] owner [ ] leased
If leased, indicate the period covered : _____________________________________
[ attach a copy of lease contract of agreement ]

5. General Project Objectives

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________

6. Alternatives
Alternative use of the proposed project site :
__________________________________________________
Alternative site for the proposed project :
____________________________________________________

B. PROJECT DESCRIPTION

1. Description of Project Phases

a. Pre-construction/construction phase
[ ] Activity(ies) Timeframe
[ ] Plans / design
[ ] Permits / clearances
[ ] Site development
[ ] Structure preparation
[ ] Concrete works
[ ] Masonry works
[ ] Roofing works
[ ] Carpentry works
[ ] Ceiling works
[ ] Metal works
[ ] Glass works
[ ] Floor works
 [ ] Painting works
[ ] Plumbing works
[ ] Electrical works
[ ] Sewage/wastewater treatment facility
[ ] Others, pls. Specify

a.1 Machinery/Equipment
No . of units Machinery / Equipment Specifications
Backhoe
Payloader
Jackhammer
Cement mixer
Others, pls. Specify

[ use additional sheet, if necessary ]

a.2 Surface development

_______ m2 – total surface development block/construction area

_______ m2 –total area to be opened for civil works within the block
Breakdown of development area :
_______ m2 –restaurant
_______ m2 –common toilets and utility rooms
_______ m2 –gas and pump rooms
_______ m2 –stockroom
_______ m2 –office
_______ m2 –parking space and sidewalk
_______ m2 –other developments ( please specify )

a.3 Others

Source of construction materials : __________________________________________

Estimated cut soil volume : __________________________________________
Total Manpower Requirement : __________________________________________

b. Operation phase
Project capacity : __________________________________________

Raw materials Consumption/Day

Meat
Fish
Vegetables
Rice
Others, pls. Specify
b.1 Production process ( attach description and flowsheet of process as Annex)

b.2 Waste Production Scheme

Type of waste Source of waste Volume/day Mode of treatment

Solid
Liquid
Air emissions
Noise
Others, pls.
Specify

[use additional sheet, if necessary]

c. Abandonment phase
Facilities to be Waste generated Mode of disposal Restoration plan
abandoned

[use additional sheet, if necessary]

2. Facilities requirements

a. Water supply
No. of units Source of water supply Consumption/day
Local water district
Surface water
Deepwell
Others, pls. Specify

[use additional sheet, if necessary]

b. Power supply
No. of units Source of power supply Consumption/day
Local electric utility
Generator
Others, pls. Specify

[use additional sheet, if necessary]

Attach sketch plan/s (layout) of project site
Attach photo, front view of project site

Attach photo, left view of project site

Attach photo, right view of project site

Attach photo, back/rear view of project site

Attach photo, panoramic view of project site and its immediate vicinity

Attach photo, (others)

Attach drawing/plan of wastewater treatment facilities (with dimensions and
descriptions)
Attach drawing/plan of air pollution source and control installations ( with
dimensions and descriptions)
3. Baseline Environmental Conditions

a.1 study methods and procedures

Primary data collection YES NO Secondary data YES NO

collection
Interviews Maps
Sampling/field Reference from other
measurements & concern agencies
observations
Site inspection/surveys Books
Others (pls. Specify) Journals, newspapers,
etc.
Photographs
Others(pls. Specify)

a.2 Description of Environmental Setting

PHYSICAL ENVIRONMENT

Topology / Slope

[ ] flat/level ( 0 – 3 % )
[ ] level to undulating ( 3- 8 % )
[ ] undulating to rolling ( 8 – 18 % )
[ ] rolling to moderately steep ( 18 – 30 % )
[ ] moderately steep to steeply mountainous ( 30 – 50 % )
[ ] very steeply mountainous ( above 50 % )

Soils Drainage

[ ] sand [ ] poorly drained

[ ] sandy silt [ ] moderately drained
[ ] sandy loam [ ] well-drained
[ ] silt
[ ] silt loam
[ ] loam

Air quality

[ ] poor
[ ] fair
[ ] good

Water quality Nearby surface waterbody

[ ] poor [ ] lake
[ ] fair [ ] creek
[ ] good [ ] river
[ ] others, pls. Specify
BIOLOGICAL ENVIRONMENT

Is the project site adjacent to a natural ecosystem ? [ ] yes [ ] no

If yes, please check on the appropriate box/es:
[ ] forest [ ] grassland
[ ] coastal/marine [ ] others, pls. Specify
[ ] mangrove/marshland/wetland

Have you observe any wildlife in the area ? [ ] yes [ ] no

If yes, please enumerate:

Are there trees within the project site ? [ ] yes [ ] no

If yes, please enumerate:

Are there other vegetation within the project site ? [ ] yes [ ] no

If yes, please enumerate:
SOCIAL – ECONOMIC ENVIRONMENT

1. Total household to be affected : ___________________________________________

2. Profile of staff to be employed in the project / establishment
Number of local residents : _________________________________
Number of transient residents : _________________________________
3. Will there be health facilities (clinic, etc. ) within the project site ?
[ ] yes [ ] no
If yes, please enumerate:

4. Will the required benefits under the Labor Code and other regulations be enjoyed by the
staff ?
[ ] yes [ ] no
If yes, please elaborate:

5. Will the cultural norms/morals and lifestyle of the local inhabitants ( especially indigenous
people ) be affected by the project
[ ] yes [ ] no
If yes, please elaborate:
Attach photo of area topography

Attach photo of nearby surface waterbody

PROJECT PHASES YES NO CLASSIFICA CLASSIFICATIO PROBABILITY TIME SCALE MAGNITUDE
TION N OF (LONG- (SEVERE.
(POSITIVE ( PERMANENT OCCURRENCE TERM OR MODERATE
OR OR (LIKELY OR SHORT – OR
NEGATIVE ) REVERSIBLE ) UNLIKELY TO TERM ) INSIGNIFICAN
OCCUR) T)
Pre-construction
Construction Phase
Will there be land clearing ?
Will there be vegetation clearing ?
Please provide details.
Will there be tree-cutting ? Please
provide details.
Will there be topsoil removal /
replacement ?
Will there be excavation works and cut &
fill activities ?
Will there be other earthmoving
activities ?
Will there be stockpiling of sand/gravel
materials in the project area ?
Will there be drilling, boring and
hammering activities ?
Will there be any slope modification or
ground leveling ?
Will there be an increase in traffic
(vehicle) movement in the area ?
Will the
public / community’s access
PROJECT PHASES YES NO CLASSIFICA CLASSIFICATIO PROBABILITY TIME SCALE MAGNITUDE
TION N OF (LONG- (SEVERE.
(POSITIVE ( PERMANENT OCCURRENCE TERM OR MODERATE
OR OR (LIKELY OR SHORT – OR
NEGATIVE ) REVERSIBLE ) UNLIKELY TO TERM ) INSIGNIFICAN
OCCUR) T)
To/though the area be affected ?
Will the public / community’s access to
the area’s resources be affected ?
Will there be an increase of economic
activity in the area ?
Will there be an increase in the
availability of employment
Will there be a raise in associated project
activities ?
Will there be displacement of people in
the area ?
Will the displacement involve relocation
of affected parties ?
Will the project affect or encroach on
ancestral domain ?
Will the indigenous or local people be
affected ?
Will the women and other vulnerable
groups be affected ?
PROJECT PHASES YES NO CLASSIFICA CLASSIFICATIO PROBABILITY TIME SCALE MAGNITUDE
TION N OF (LONG- (SEVERE.
(POSITIVE ( PERMANENT OCCURRENCE TERM OR MODERATE
OR OR (LIKELY OR SHORT – OR
NEGATIVE ) REVERSIBLE ) UNLIKELY TO TERM ) INSIGNIFICAN
OCCUR) T)
Will there be solid waste generation ?
Will there be toxic and hazardous wastes
generation?
Will there be air emissions (i.e., dust, etc.
)?
Will there be wastewater generation?
Will there be risks and hazards to the
adjoining properties ?
Will there be erosion ?
Will there be risks / hazards to the
pedestrians/ passersby?
Will there be risks/hazards to the workers
?
Will there be risks / hazards to the
workers ?
Will the aesthetics of area be affected ?
Others, please specify.
Will there be site restoration ?
Will there be solid waste generation
Will there be employment generation ?
Others, please specify.
PROJECT PHASES YES NO CLASSIFICA CLASSIFICATIO PROBABILITY TIME SCALE MAGNITUDE
TION N OF (LONG- (SEVERE.
(POSITIVE ( PERMANENT OCCURRENCE TERM OR MODERATE
OR OR (LIKELY OR SHORT – OR
NEGATIVE ) REVERSIBLE ) UNLIKELY TO TERM ) INSIGNIFICAN
OCCUR) T)
Operation and Maintenance Phase
Will there be solid wastes generation ?
Will there be toxic & hazardous wastes
generation ?
Will there be air emissions ?
Will there be noise generation ?
Will there be wastewater generation ?
Will there be risks and hazards to
workers ?
Will there be employment generation
Others, please specify.

Abandonment Phase
Will there be facilities to be abandoned or
demolished at the end of project life ?
Please provide details.
Will any of the facilities be rehabilitated
after a certain period of time ?
 DESCRIBE YOUR MITIGATION / Parameters Area / Frequenc Procedur Responsible
ENHANCEMENT MEASURES to be stations y es to be Persons
monitored used for
sampling
and
laborator
y
analysts
Pre-Construction /
Construction Phase
Land clearing
Vegetation clearing
Tree-cutting
Topsoil removal / replacement
Excavation works and cut &
fill activities
Other earthmoving activities
Stockpiling of sand/gravel
materials in the project area
Drilling, boring and
hammering activities
Slope modification or ground
leveling
Increase in traffic
(vehicle) movement in the
area
Alteration of public /
community access to/through
the area’s resources
Increase economic activity
Increase availability of
employment
Raise in associated project
activities
Displacement of people in the
area
Encroachment on ancestral
domain
Effect on indigenous or local
people
Effect on women and other
vulnerable groups
Solid waste generation
Toxic and hazardous waste
generation

Air emissions (i.e., dust, etc.)

Noise generation
Wastewater generation
Risks and hazards to
adjoining properties
Erosion/landslide
Risks/ hazards to the
pedestrians/passers-by
Risks/hazards to the workers
Alteration of the aesthetics of
area
Others, please specify.

Operation and Maintenance

Phase
Solid wastes generation Solid waste management :
[ ] Collection by LGU Sanitation Unit
volume per collection :
__________m3/day
frequency of collection :
___________/wk
Types and forms of wastes : [ ] Burning
volume per burning :
___________m3/day
frequency of burning : __________/wk
Amount generated / day : [ ] Composting
volume per composting :
_________m3/day
frequency of composting:
__________/wk

[ ] Garbage Pit
volume per burial :
_____________m3/day
frequency of burial :
______________ /wk

[ ] Others, please specify

volume per cycle :
____________m3/day
frequency of cycle :
______________/wk

[ ] Others, please specify

volume per cycle :
____________m3/day
frequency of cycle :
______________/wk

[ ] Others, please specify

volume per cycle :
____________m3/day
frequency of cycle :
______________/wk

Toxic & hazardous wastes

generation
Air emissions
Noise generation
Wastewater generation Sewage/wastewater treatment(check
 appropriate box ) :
[ ] Septic tank
type :
capacity : _________m3/day
[ ] Wastewater treatment
type : __________________
capacity : _________m3/day

Receiving body of water :

Describe operation :
Risks and hazards to workers
Employment generation
Others, please specify.

DESCRIBE YOUR MITIGATION / Parameters Area / Frequenc Procedur Responsible

ENHANCEMENT MEASURES to be stations y es to be Persons
monitored used for
sampling
and
laborator
y
analysts
C. PROPONENT’S COMMITMENTS

ARE YOU WILLING TO … YES NO

Comply with existing environmental rules and
regulations, guidelines and criteria?
Participate or support multi-partite monitoring
efforts?
Construct, maintain and properly operate an
adequate and appropriate treatment facility for
your liquid waste ?
Contribute toward the operation and
maintenance of a municipal sewerage facility ?
Construct, maintain and properly operate an
adequate and appropriate storage and
disposal facilities for your solid wastes?
Contribute towards the operation and
maintenance of municipal solid waste
management/disposal facility ?
Maintain the cleanliness of your general
surroundings ?
Extend social benefits to the community ?

Organize and conduct information, education

and communication (IEC) activities on
environmental, health and other civic issues ?
Pay environmental tax or fee should this be
deemed necessary by the appropriate
authority to maintain an environmental friendly
area ?
Contribute (on cost-sharing basis ) in
government undertakings on pertinent (fast-
food related) issues (e.g., workshop, training,
etc.)
Other, please specify
As stated in Article VI Section 10 and Article V Sections 1 to 6, certain project are required to : a) organize a Multipartite Monitoring Team (MMT)
and b) establish Environmental Monitoring Fund (EMP)/Environmental Guarantee Fund (EGF). In case an Environmental Compliance Certificate
(ECC) is issued for this project, are you willing to :

a) participate or support a Multipartite Monitoring Team ? ____________ yes ______________ no

b) establish an EMF/ EGF ? ____________ yes ______________ no
If yes, what is your proposed annual contribution ? ________________________ PhP / year

D. ATTACHMENTS

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

PERMITS / CLEARANCES ATTACHED? PERMITS / CLEARANCES ATTACHED?

Demolition Permit Locational clearance / Certificate
Excavation Permit of Locational Viability
Electrical Permit DTI / SEC Registration
Sanitary Permit Safety ( Fire ) Permit
Building Permit Municipal / Business Permit
Water Rights Permit ( NWRB )

2. IEE Attachments (final reminders )

DESCRIPTION
Transfer Certification of Title
Colored photos of the site
(different perspectives )
Project Vicinity Map/Sketch
Project Lay-out Plan
Sewerage and Drainage Plan
WT. Plan
DESCRIPTION ATTACHED?
ATTACHED? Map / Delineation of primary and
secondary impact areas
Endorsement from the Local
Government Unit / Proof of the
project’s social acceptability
Construction schedule in chart
form
Lease Contract of Agreement
 ACCOUNTABILITY STATEMENT

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

I/We hereby bind myself/ourselves jointly and solidarity for any penalties that may be imposed arising from and misrepresentations or
failure to state material information in the IEE. As permitted under section bc of Article

In witness whereof, we hereby set out hands this _______day of ___________________________

_______________________at __________________________________.

_________________________________________________
Project Proponent

_________________________________________________
Title/Designation

_________________________________________________
Date
 ACKNOWLEDGMENT

BEFORE ME this (day) ______________of ________________19__________________at (place)__________________________,

personality appeared name____________________________________ with Community Tax Certificate No.
_______________________________issued on date_________________At (place)____________________, in his/her capacity as
______________________(designation_________________at ___________________ and acknowledged to me that this IEE is his voluntary
act and deed, and voluntary act and deed of the entity he/she represents. This document
which consists of (no)_____________________________pages, including the page of which this acknowledgment is ,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 __________________