Documente Academic
Documente Profesional
Documente Cultură
(CHECKLIST FORMAT)
____________________________________________
(No other documents shall be required as pre-requisite to ECC applications per DENR MC
2010-14)
Read the questions carefully and write the required information on the blank spaces
provided or otherwise check () the appropriate boxes □ or parenthesis ( ). Boxes with
check marks () are automatically required. Use additional sheets if necessary and indicate
this in the appropriate space.
Project Name:
Project Address:
Office Address:
Contact Person:
Designation:
Contact Number/s
Landline : ________________________________________________
Fax Number: ________________________________________________
Mobile : _________________________________________________
E-mail Address: _________________________________________________
1.1 PROJECT LOCATION AND AREA: Street Name, Barangay, and Municipality/City,
Province
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
See attached vicinity map/s and photographs of the project site and site development/layout
plan (include existing project component in the layout)
Geographic coordinates of the project area (Preferably use PRS 92 datum, otherwise specify
datum used).
Perimeter/Boundary points
(based on OCT/TCT/etc) Longitude Latitude Longitude Latitude
Existing Expansion
Support Facilities
(e.g. emergency
generators,
boilers, etc.)
Admin support
(e.g., canteen,
office, clinic,
quarters, etc.)
Water source /
supply
Waste water
management
Facility
Solid waste
management
facility
Drainage system
Existing Expansion
Power/Electricity
KWh KWh
(Total)
Power/Electricity
(From Renewable KWh KWh
Energy Sources)
Water
(Total)
Cubic
(Fill-up table below if water Cubic meters/day
meters/day
is not obtained from the
local water utility)
Water
Cubic
(Rainwater Collection Cubic meters/day
meters/day
System)
Water Source(Domestic)
Existing Expansion
Energy/Water Efficiency
Utilities Estimated Efficiency/Conservation Estimate Efficiency/Conservation
Savings Measures d Measures
Savings
Existing Expansion
Power/ KWh
Electricity
Water Cubic
meters/day
a. Construction Phase
Manpower Expertise/Skills Total Expertise/Skills Total
Requirement
Existing Expansion
b. Operation Phase
Manpower Expertise/Skills Total Expertise/Skills Total
Requirement
Existing Expansion
Competition in water Size of population using receiving Implement rainwater Regularly monitor Cost
use surface water: harvesting and similar presence/absence of integrated in
Depletion of water ≤ 1,000 persons measures as an alternative complaints the
resources >1,000 and ≤ 5,000persons source of water Regular coordination construction
>5,000person Observe water with concerned / operation
conservation measures; agencies cost
Available/nearest water source. Careful selection of project Regularly monitor
occurrences of water
Deepwell site to avoid disruption of
shortages
traditional water uses
Water district/LGU Others, specify
Surface water Obtain Water Permit from
NWRB ____________
Others, specify Improve efficiency of water
________________________
supply and distribution
system
Others, specify
_____________________
Increased occurrence Is the project site located in an Use appropriate design for Regularly monitor Cost
of flooding area identified by MGB/PAG-ASA project facilities presence/absence of integrated in
as flood prone?
Implement appropriate complaints the
Yes drainage system Regular coordination construction
No Regularly remove debris with concerned / operation
agencies cost
and other materials that
may obstruct water flow Regularly monitor
AIR / NOISE
Nuisance due to noise Distance to nearest community: Properly operate and Regularly monitor Cost
generation 0 to less than 0.5 km maintain all noise sources presence/absence of integrated in
0.5 to 1 km (e.g. vehicles, pumps, complaints the
More than 1 km generator, etc) Regular monitoring construction
Install when applicable, the of buffer zones / operation
appropriate noise control cost
device/s (e.g., mufflers,
silencer, sound barriers,
etc.)
Implement appropriate
operating hours
PEOPLE
Displacement of Size of population of host Provide Regularly monitor Cost
residents in the project barangay: relocation/disturbance presence/absence of integrated in
site and within its ≤ 1,000 persons compensation packages complaints the
vicinity >1,000 and ≤ 5,000persons Prioritize local residents for Regular coordination construction
Displacement of >5,000person employment with LGU / operation
Indigenous People Promptly pay local taxes Others, specify cost
Enhanced Classification of host barangay: and other financial _________________
obligations
employment and/or Urban
livelihood Regular coordination with
opportunities Rural LGU
Reduced employment Available services within/near the Prior consultation &
and/or livelihood host barangay: coordination to minimize
opportunities disruption on daily domestic
Increased revenues
Schools (e.g. elementary, high activities & respect for IP
school, college) rights and cultural practices
for LGU
Disruption/Competition
Health facilities (e.g., clinics, Ensure participation of IPs
hospitals, etc.) in consultations and
in delivery of public
services (e.g., Peace and order (e.g., police dialogues
education, peace and outpost, brgy. Tanod, etc.) Provide appropriate
order, etc.) Recreation and sports facilities traffic/warning signs,
Enhanced delivery of Others, specify lighting, etc
Implement appropriate
safety programs for both
community and workers
Strictly comply with fire,
safety and similar
regulatory requirements
A. PROPONENT’S COMPLIANCE
Were they
MITIGATING MEASURES
Effective? RECOMMENDATION/s / REMARKS
Which of the following mitigating measures were actually implemented? Y N
LAND
Compliance with conditions of DENR/LGU SLUP, Tree Cutting Permit,
ROW, PCA Permit
Limit land clearing as much as possible
Provide temporary fencing for vegetation that will be retained
Promote restoration of damaged or destroyed vegetation where possible
(e.g., tree planting);
Compliance with the DENR Administrative Order No. 2003-30 and DENR
Administrative Order No. 2000-28, Implementing Guidelines on Engineering
Geological and Geo-hazard Assessment (EGGA).
WATER
AIR
Properly operate and maintain all emission sources (e.g. vehicles, pumps,
generator, etc)
Install when applicable, the appropriate air pollution control device/s
Properly operate and maintain all noise sources (e.g. vehicles, pumps,
generator, etc)
Install when applicable, the appropriate noise control device/s (e.g.,
mufflers, silencer, sound barriers, etc.)
Implement appropriate operating hours
Provide adequate buffer and/or planting of trees
PEOPLE
TYPE OF ADEQUATE?
HANDLING STORAGE DISPOSAL REMARKS
WASTE Y N
1
2
3
N
TYPE OF ADEQUATE?
HANDLING STORAGE DISPOSAL REMARKS
WASTE Y N
Biodegradable
Non
biodegradable
A.7 Compliance with good practices in CHEMICAL SAFETY Management (for those companies using/producing chemicals listed in EMB’s PCL
and CCO list)
1. Is there a system for identifying and responding to community and stakeholder concerns? □ □
2. Is there a system for informing the community and other stakeholders on environmental matters relative
□ □
to the company’s current operations?
3. Is the company implementing a community development project or any project directed towards
□ □
improving stakeholders
C. COMPLAINTS MANAGEMENT
Yes No
1. Has the company/proponent received any complaints from the surrounding community and/or
□ □
other stakeholders due to pollution or other nuisances caused by its operation?
Yes No
2. Has the company/proponent addressed the complaint by implementing a complaints management
□ □
system?
3. Have the appropriate government agencies and other interested parties been informed about the
□ □
resolution of the complaint?
Provide description of the Abandonment activities for existing and proposed expansion, such as,
dismantling and waste disposal.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______________________________________________
This is to certify that all the information and commitments in this Environmental
Performance Report and Management Plan (EPRMP) are accurate and complete to the best of
my knowledge.
I hereby bind myself to answer any penalty that may be imposed arising from any
misrepresentation or failure to state material information in this EPRMP.
__________________________
NAME OF PROPONENT HEAD
(Position)
(Company Name)
SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant
exhibiting his/her Community Tax Certificate No. ___________________ issued at
______________________ on __________________________.
Doc. No.
____________________
Page No.
____________________
Book No.
____________________
Series of
____________________