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 :
Municipality : Gigmoto
Province : Catanduanes
Region :V

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.

Site Sensitivity
Area of Concern RATING Remarks
Low Medium High
Natural Habitats No natural No critical natural Critical natural
habitats habitats; habitats
present of present;
any kind
Other natural Within declared
habitats occur protected areas

Water quality Water flow

and water rate exceeds
resource existing
availability and demand;
use
Low water Medium water Intensive water
utilization utilization rate; utilization;
rate multiple water multiple water
users users
Low potential With medium With medium
for water potential for potential for
utilization- water utilization- water
related related conflicts; utilization-
conflicts; no with existing related
existing water utilization- conflicts; with
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Site Sensitivity
Area of Concern RATING Remarks
Low Medium High
water related conflict/sf existing water
utilization- utilization-
related related
conflict/s conflict/s

No potential With medium With high

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

Natural hazards Flat terrain; Medium slopes; Mountainous

vulnerability, terrain; steep
floods, soil slopes
stability/erosion
No potential Some erosion Unstable soil;
stability/erosi potential; high erosion/
on problems; landslide
potential;
erosion/landslid
e-prone

No known Medium High

volcanic/seis volcanic/seismic, volcanic/seismi
mic /flood flood, and/or c, flood and/or
risks typhoon risks typhoon risks

Physical Cultural No known or Suspected Declared/

Property suspected cultural heritage known heritage
sites; known sites in
heritage sites in subproject area
broader area of
influence
Involuntary Low Medium High population
Resettlement population population density; major
density; density town and
dispersed villages
population
Legal tenure Mixed ownership Low-income
is well- and land tenure families and/or
defined illegal
ownership of
land
Communal
properties
Indigenous No Dispersed and Indigenous
Peoples indigenous mixed indigenous territories
population populations; (CADT),
reserves and/or
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Site Sensitivity
Area of Concern RATING Remarks
Low Medium High
lands
Highly- Vulnerable
acculturated indigenous
indigenous populations
populations
Other factors or
conditions distinct NONE NONE NONE
to the area

II. Areas for Potential Environmental and Social Impact

Ye N Remark
s o s
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)?
1 Result in the production of solid or liquid waste, or result in an increase in waste
0 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:

1 Require that land (public or private) be acquired (temporarily or permanently) for
1 its development/sub-project implementation?
1 Use land that is currently occupied or regularly used for productive purposes (e.g.
2 gardening, farming, pasture, fishing, forests)?
1 Physically or economically displace1 individuals, families, businesses?
3
1 Have any individuals, families, businesses been displaced up to 2 years prior to

1
Loss of income sources and means of livelihood due to land acquisition.
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

Ye N Remark
s o s
4 sub-project enrolment?
1 Result in the temporary or permanent, partial or total loss of crops, fruit trees,
5 fixed assets, and/or household infrastructure such as crop storage facilities,
outside toilets and kitchens?
1 Result in the involuntary restriction of access by people to legally designated
6 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:
1 Any indigenous groups living within the boundaries of the barangay where the
7 subproject will be located?
1 Resources (land, water, etc.) to be used for the sub-project, over which the
8 Indigenous People have prior claim?
1 Members of these indigenous groups who would be affected (i.e. benefit from, or
9 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.
2 Will the subproject increase agricultural productivity? This may happen when the
0 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.
2 Will sub-project implementation require mass gatherings or a group of people Pls. see
1 working together? attached
ESMP.
2 Will sub-project implementation result in the production of waste such as used Pls. see
2 PPE’s, etc.? attached
ESMP.

III. Other Important Field Data/Information

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
If the screening and the SIA indicate that the proposed project will have impacts, positive and/or
negative, on Indigenous Peoples, the borrower/client will prepare the IPP in the context of the SIA and
through meaningful consultation with the affected Indigenous Peoples communities. However, for sub-
projects where IPs are the sole or overwhelming majority of direct project beneficiaries, and when only
positive impacts are identified, a stand-alone IPP will not be required. Elements of an IPP (meaningful
consultations, information disclosure, and beneficial measures to IP communities) are included in the
overall project design documents (such as CMP) and a report of these sub-projects (including
assessment of the benefits accruing to IP communities) will be submitted as part of the periodic project
progress reports submitted to the DSWD.
CBIM 2021 Form 19
Environmental and Social Safeguards Checklist

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 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 : ______________________

Name and Signature

BDC-TWG Chairperson : _______________________

Name and Signature

BDRRMC Head : _______________________

Name and Signature

ACT TF : _______________________
Name and Signature

MCT TF : _______________________
Name and Signature

MCT CEF : _______________________

Name and Signature

RPMO Representative : _______________________

Name and Signature