CBIM 2021 Form 19

Environmental and Social Safeguards Checklist

KALAHI-CIDSS National Community-Driven Development Program

Additional Financing

Environmental and Social Safeguards Checklist

Site Investigation

Barangay : BACJAWAN SUR

Municipality : CONCEPCION
Province : ILOILO
Region : VI

I. Preliminary Site Investigation

When conducting a site investigation to identify environmental and social factors that may affect
subproject design, implementation, and operations and maintenance, the following, among others,
are to be checked. Higher sensitivity or the presence of potential environmental and social
impacts do not necessarily indicate the unsuitability of the area, but instead mean that more
substantial environmental and/or social planning may be required to adequately avoid, mitigate or
manage potential effects.

Area of Site Sensitivity

Rating Remarks
Concern Low Medium High
Natural No natural No critical Critical
Habitats habitats natural natural
present of habitats; habitats LOW
any kind present;

Other natural Within

habitats occur declared
protected
areas
Water quality Water flow
and water rate
resource exceeds LOW
availability and existing
use demand;

Low water Medium water Intensive

utilization utilization rate; water LOW
rate multiple water utilization;
users multiple
water users

Low With medium With medium

potential potential for potential for
for water water water LOW
utilization- utilization- utilization-
related related related
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Area of Site Sensitivity

Rating Remarks
Concern Low Medium High
conflicts; conflicts; with conflicts;
no existing existing water with existing
water utilization- water
utilization- related utilization-
related conflict/s related
conflict/s conflict/s

No With medium With high

potential potential for potential for
water water quality water quality LOW
quality issues; with issues; with
issues; no existing water existing
existing quality issues water quality
water issues
quality
issues

Natural Flat terrain; Medium Mountainous

hazards slopes; terrain; steep LOW
vulnerability, slopes
floods, soil
stability/erosio No Some erosion Unstable soil;
n potential potential; high erosion/
stability/er landslide
osion potential; LOW
problems; erosion/lands
lide-prone

No known Medium High Flood risks

volcanic/se volcanic/seism volcanic/seis in the sub-
ismic ic, flood, mic, flood MEDUIM project site
/flood risks and/or and/or
typhoon risks typhoon risks

Physical No known Suspected Declared/

Cultural or cultural known
Property suspected heritage sites; heritage sites LOW
known heritage in subproject
sites in broader area
area of
influence
Involuntary Low Medium High
Resettlement population population population
density; density density; LOW
dispersed major town
population and villages
Legal Mixed Low-income
tenure is ownership and families
well- land tenure and/or illegal LOW
defined ownership of
land
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Area of Site Sensitivity

Rating Remarks
Concern Low Medium High
Communal
properties
Indigenous No Dispersed and Indigenous
Peoples indigenous mixed territories
population indigenous (CADT), N/A
populations; reserves
and/or lands
Highly- Vulnerable
acculturated indigenous N/A
indigenous populations
populations
Other factors
or conditions N/A
distinct to the
area

II. Areas for Potential Environmental and Social Impact

Yes No Remarks
A. Environment
If the answer to nay question from 1-10 is “Yes,” please include an Environmental and
Social Management Plan (ESMP) with the subproject application.

Will the sub-project:

1 Risk the contamination of drinking water? /
2 Cause poor water drainage and increase the risk of water-related /
diseases such as malaria, dengue and schistosomiasis?
3 Harvest or exploit a significant amount of natural resources such /
as trees, wood for fuel or water?
4 Be located within or nearby environmentally sensitive areas, /
protected areas (e.g. intact natural forests, mangroves, wetlands or
threatened species)?
5 Create a risk of increased soil degradation or erosion? /
6 Located in an erosion-/landslide-prone area? /
7 Create a risk of increasing soil salinity? /
8 Produce, or increase the production of solid wastes (e.g. water, /
medical/healthcare, domestic or construction wastes)?
9 Affect the quantity or quality of surface waters (e.g. rivers, /
streams, wetlands) or groundwater (e.g. wells)?
10 Result in the production of solid or liquid waste, or result in an /
increase in waste production, during construction or operation?
B. Land Acquisition and Access to Resources
If the answer to any of the questions from 11-16 is “Yes,” please inform the RPMO and
prepare appropriate documents required under the LARR Framework (see Annex G).

Will the sub-project:

11 Require that land (public or private) be acquired (temporarily or /
permanently) for its development/sub-project implementation?
12 Use land that is currently occupied or regularly used for /
productive purposes (e.g. gardening, farming, pasture, fishing,
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Yes No Remarks
forests)?
13 Physically or economically displace1 individuals, families, /
businesses?
14 Have any individuals, families, businesses been displaced up to 2 /
years prior to sub-project enrolment?
15 Result in the temporary or permanent, partial or total loss of /
crops, fruit trees, fixed assets, and/or household infrastructure
such as crop storage facilities, outside toilets and kitchens?
16 Result in the involuntary restriction of access by people to legally /
designated parks and protected areas2?

C. Indigenous People
If the answer to any of questions 17 – 19 is “Yes,” please inform the RPMO
and if needed, prepare an Indigenous Peoples Plan (IPP) 3

Are there:
17 Any indigenous groups living within the boundaries of the /
barangay where the subproject will be located?
18 Resources (land, water, etc.) to be used for the sub-project, over /
which the Indigenous People have prior claim?
19 Members of these indigenous groups who would be affected (i.e. /
benefit from, or be adversely affected) by the sub-project?
D. Pesticides and Agricultural Chemicals
If the answer to Question 20 is “Yes,” please inform the RPMO and coordinate with the
Municipal Agricultural Officer of the LGU. Integrated Pest Management techniques should
be promoted among the beneficiaries.
20 Will the subproject increase agricultural productivity? This may /
happen when the subproject is an irrigation or water impounding
activity.
E. COVID-19 Health Protocols
If the answer to any of questions 21-22 is “Yes,” please prepare an ESMP.
21 Will sub-project implementation require mass gatherings or a /
group of people working together?
22 Will sub-project implementation result in the production of waste /
such as used PPE’s, etc.?

III. Other Important Field Data/Information

CERTIFICATION

We certify that we have thoroughly examined and discusses all the potential adverse effects of
this sub-project. To the best of our knowledge, the subproject plan as described in the application
1
Loss of income sources and means of livelihood due to land acquisition.
2
E.g. the project will affect access to natural resources, communal facilities, and services; due to change in
land use, project will have an adverse impact on social and economic activities; access to land and
resources owned communally or by the state will be restricted due to the project.
3
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

and associated planning reports (e.g. ESMP, RAP, IPP), if any, will be adequate to avoid or
minimize all adverse environmental and social impacts.

PPT Representative : LOVELYN B. ARBIS

Name and Signature

BDC-TWG Chairperson : MEYCHEL E. REYES

Name and Signature

BDRRMC Head : NONNY N. VILLARIAS

Name and Signature

ACT TF : ENGR. MARY ROSE P. TEAÑO

Name and Signature

MCT TF : ISAGANI D. VALDERRAMA

Name and Signature

MCT CEF : MARIBEL B. LOCSON

Name and Signature

RPMO Representative : NELSON P. CAJADA JR

Name and Signature