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EPRMP CHECKLIST FOR EXPANSION OF PRIMARY HOSPITAL OR MEDICAL

FACILITIES
A.

INTRODUCTION

The Philippine Environmental Impact Statement System was formally established by virtue
of Presidential Decree 1586. It requires the submission of Environmental Impact Statements
(EIS) for environmentally critical projects and Initial Environmental Examination (IEE) for
projects which are located in environmentally critically areas as provided in its Implementing
Rules and Regulations (IRR) and Presidential Proclamation No. 2146, series of 1981.
In 2003 DENR issued Department Administrative Order 30 (DAO 03-30) to further
strengthen the EIS System. DAO 03-30 Article II, Section 5.2.2 provides that EPRMP
Checklist is similar to EPRMP, but with reduced details of data and depth of assessment and
discussion. It may be customized for different types of projects under Category B. The EMB
shall coordinate with relevant government agencies and the private sector to customize and
update EPRMP Checklist to further streamline ECC processing, especially for projects with
minimum impacts.
The attached Environmental Performance Report and Management Plan (EPRMP)
Checklist for ECC application for Primary Hospital or Medical Facilities proposing to
expand their activity, is a continuous effort by the Environmental Management Bureau
through the Environmental Impact Assessment and Management Division to further assist
the Department of Health in the implementation of its Administrative Order No.70-A Series of
2002.
B. CONTENTS OF THIS GUIDE
This guide is produced to aid the proponent in preparing and submitting an EPRMP
Checklist to secure an Environmental Compliance Certificate (ECC) for their existing and
expansion projects.
This guide contains the following:
Part 1-

Scope and Coverage of the EPRMP Checklist for Expansion of


Primary Hospitals or Medical Facilities

Part II

Instructions for the Preparation and Submission of the EPRMP


Checklist

Part III

Definition of Terms of EPRMP Checklist for Expansion of Primary


Hospitals or Medical Facilities

Part IV

EPRMP Checklist Form

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I.

SCOPE AND COVERAGE

This section defines the scope and limitations to be covered and affected by this EPRMP
checklist. Such that projects with greater than the defined scope, the proponent shall be
required to submit an Environmental Performance Report and Management Plan or IEE
Report for Secondary or an Environmental Impact Statement Report for Tertiary Hospitals.
This Checklist is applicable only for Primary Hospitals or Medical Facilities proposing to
expand their activity in terms of service capability, area, personnel, equipment/instrument
and physical plant.
Primary or First Level Referral Hospitals includes:
a. Non-departmentalized hospital (clinical cares)
b. Clinical services include general medicine, pediatrics, obstetrics and
gynecology, surgery and anesthesia
c. Clinical Laboratory, radiology, and pharmacy
d. Nursing care with partial category of supervised care for 24 hours on longer

II.

INSTRUCTIONS ON THE PREPARATION AND SUBMISSION OF THE EPRMP


CHECKLIST

This section guides the project proponent on how to fill-up and answer the various questions
and information stated in the checklist. This section also informs the project proponent on
permit requirements that need to be attached to the Checklist. Likewise, it directs the
proponent where to submit the EPRMP Checklist and apply for an ECC and also the
procedures and timeframe for processing.
A.

Contents of the EPRMP Checklist

The EPRMP Checklist serves as tool designed to assist proponents' of selected projects in
complying with the EIS system. The EPRMP Checklist, consists of a series of questions that
deals with issues and concerns about the proposed project and its environment providing the
proponents with information on environmental impacts, both positive and negative, which will
be caused by the proposed project. In addition, it summarizes the proponents record of
compliance to environmental rules and regulations and requirements by the Bureau of
Health Facilities and Services of the Department of Health (DOH).
The Checklist has to be submitted by all government and private sector proponents applying
for an ECC covering the expansion of the mentioned projects. The information contained
herein will serve as basis for EMB to make a decision on the application for ECC.
The EPRMP Checklist is divided into six (5) major sections:

Section 1. Required Information - consist of the attachments required to be


submitted as part of the EPRMP Checklist

Section 2. General Information presents the project title, name and address
of the project proponent, proponent's contact person and the location of the
project;

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B.

Section 3. Project Description presents the plan/design components and


activities during the construction and operation phases of the project;

Section 4. Documentation of Environmental Performance and Regulatory


Compliance illustrates the capability of the proponent to mitigate environmental
impacts of the project. It also provides the compliance of the project to DOH
licensing requirements, prescribed guidelines, and the management of service
capability, personnel, equipment and physical plant;

Section 5: Environmental Management System-Based Environmental


Management Plan (EMS-based EMP) & Environmental Monitoring Plan
(EMoP) enhances the proponents use of resources, instead of just focusing on
compliance, the EMS-based EMP aims to reduce the usage of water, energy and
the generation of wastes and emissions through setting up of objectives and
indicators to monitor each environment management program;

Instructions to Fill-up the EPRMP Checklist


1. For the Section 1: Required Information, write a check mark () on the title or
description of the document to be submitted. The listed documents are MUST
requirements and should be submitted. Otherwise, the application will not be
accepted.
2. The Checklist can be prepared by the proponent or any of his/her authorized
representative per EMB Memorandum Circular No. 04, Series of 1998 (17 August
1998). The proponent's signature in the report shall be sufficient.
3. To use the Checklist, the proponent may put a check () mark in the appropriate box.
If your answer does not fall in any of the pre-determined responses, check ()
OTHERS and indicate your specific answer in the blank space provided or use
additional sheets as necessary. If some questions are not applicable to your project,
write N/A on the blank space or column.
4. Answers to the questions are not strictly confined to the pre-determined responses.
The proponent may elaborate and use as many additional sheets as needed to be
able to provide adequate answers to the required information. Maps, pictures,
drawings (e.g. charts, tables, diagrams, sketches) and other visual aids are deemed
to provide better description of the information provided in the Checklist. These will
help EMB in understanding the proposed project, and make decision on the
application for an ECC.

C.

Instructions on the Submission of the EPRMP Checklist


1.

Upon completion of the checklist, the project proponent shall submit one (1) set of
the Checklist at the EIAM Division of the EMB Regional Office where the project is
to be located.

2.

Upon the presentation/submission of the Checklist, the Screening Officer shall


immediately determine its completeness and conformance with the DENR
prescribed requirements.

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3.

The Screening Officer shall indicate under the Remarks/Applicable column, the
presence or absence of a particular information required.

4.

The determination of the completeness of the Checklist will be based on the


sufficiency of responses to all questions or checklist and information provided in the
matrix.

5.

If the Checklist is complete, it will be officially accepted. The proponent will be


furnished a copy of the accomplished procedural screening form duly signed by the
Screening Officer.

6.

If the Checklist is incomplete, it shall be immediately returned to the proponent for


revision or submission of the missing requirement/information. The reason for nonacceptance shall be stated in writing at the appropriate space in the form.

7.

If the Checklist has complied with all the DENR prescribed requirements, the
proponent shall submit 3 copies of the documents to EIAM Division of the concerned
EMB Regional Office.
The proponent shall pay the amount of P3,000.00 at the Cashier Section of
concerned EMB Regional Office upon submitting the required number of copies at
the Record Section of the same office.

8.

The project proponent or his duly recognized representative shall be authorized to


follow-up the said application to the respective EMB Regional Office. The
processing time including the issuance and/or denial of the ECC will take a
maximum of 30 days.

9.

The EIAM Division of EMB Regional Office, in the course of substantial review, may
conduct site visit or ocular inspection in coordination with the project proponent.

10. If the EMB finds that the Checklist has substantially addressed all the significant
impacts and relevant issues by way of mitigation and enhancement measures, it
shall recommend the issuance of the ECC. The EMB Regional Office may call for a
technical conference to explain to the project proponent the relevance of the ECC
and the various conditions stated therein for compliance by the project proponent.
III.

DEFINITION OF TERMS

EPRMP Checklist

refers to Environmental Performance Report and Management


Plan Checklist

Project Name

refers to official name of project

Project Location

refers to location of the project. Proponent should provide


complete physical description of the location of the project
(e.g., diversion canal, service canals, barangay/sitios
affected, etc.) as well as its political boundaries (e.g., sitio,
barangay, town/municipality, province, etc.)

Project Description

provide short description of the project (e.g., dimensions of


diversion and service canals, material of construction,
service areas, etc.)

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Name of Proponent

refers to the owner of the The appropriate DENR/EMB


office (which issued the ECC/CNC) shall be informed of
the change in proponent when the turnover to the
association has been completed.

Contact Person

refers to person/s who is authorized to transact bwith


DENR/EMB on behalf of the Proponent (e.g., mayor,
municipal engineer, project engineer, etc.)

Address

refers to official address of proponent and contact


person/s. The address of contact person/s should also be
given if different from that of the proponent.

Hospital Waste

refers to all waste generated, discarded ad not intended


for further use in the hospital

General Waste

refers to largely composed of domestic or house hold type


waste. It is non-hazardous to human beings, e.g kitchen
waste, packaging material, paper, wrappers, plastics

Pathological waste

consists of tissue, organ, body part, human foetuses,


blood and body fluid. It is hazardous waste

Infectious waste

wastes
which
contain
pathogens
in
sufficient
concentration or quantity that could cause diseases. It is
hazardous e.g. culture and stocks of infectious agents
from laboratories, waste from surgery, waste originating
from infectious patients.
Waste materials which could cause the person handling
it, a cut or puncture of skin e.g. needles, broken glass,
saws, nail, blades, scalpels.

Sharps

Pharmaceutical waste

includes pharmaceutical products, drugs, and chemicals


that have been returned from wards, have been spilled,
are outdated, or contaminated

Chemical waste

comprises discarded solid, liquid and gaseous chemicals


e.g. cleaning, house keeping, and disinfecting product.

Radioactive waste

includes solid, liquid, and gaseous waste that is


contaminated with radionucleides generated from invitro analysis of body tissues and fluid, in-vivo body
organ imaging and tumour localization and therapeutic
procedures.

IV.

EPRMP CHECKLIST FORM (see attach sheet)

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ENVIRONMENTAL PERFORMANCE REPORT AND MANAGEMENT


PLAN (EPRMP) CHECKLIST FORM FOR EXPANSION OF PRIMARY
HOSPITALS OR MEDICAL FACILITIES
(Fill-up the necessary information applicable for expansion of the existing facilities only, write NA if not
applicable)

SECTION 1. REQUIRED INFORMATION


This section presents the various information required to be submitted by the project
proponent as attachments to the EPRMP Checklist, without which the application for ECC
will not be accepted.
Attachments
Remarks
1. Letter Request/Covering Letter from the proponent
2. SEC Registration or DTI Certification of the proprietor (for
Private hospital or other health facility)
3. Enabling Act (for national government hospital or other
health facility)
4. Colored Pictures of the existing facility(ies) (panoramic
view with captions)
5. Approved Board Resolution (for local government hospital
or other health facility) for the proposed expansion
6. Topographic Map/ vicinity map (1:10,000)
7. Certified copy of the TCT or OCT (if the TCT or OCT is
not with the name of the applicant, SPA or Joint Venture
Agreement will be required)
8. Accountability Statement of Project Proponent(s)
9. Accountability Statement of EIA Preparer/consultant (if
applicable)
10. Approval from DOH on the existing operation of the
hospital
11. Receipt of the Processing Fee (worth Php 3,000.00)

OR No. :______________
Date: ________________

Action Taken:
Complete
Incomplete

, submit in _____ copies


, not accepted

Screening Officer:

Noted by:

_______________________
Signature over Printed Name
EIAM Division, EMB
Date : ___________

____________________________
Signature over Printed Name
EIAM Division/Section Chief
Date:__________________

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SECTION 2.

GENERAL INFORMATION

2.1

Project Name

: _________________________________________

2.2

Project Location

: _________________________________________
_________________________________________
(complete address, barangay/ street/sitio/
municipality/city, province)

2.3

Project Type

: _________________________________________

Proponent Name

: _________________________________________

Contact Person

:__________________________________________

Designation and Position : _______________________________________

2.4

Office Address

:__________________________________________

Tel/Fax No. (office)

:__________________________________________

Tel/Fax No. (site)

:__________________________________________

E-mail address

:__________________________________________

Project Ownership
Type of Ownership :
[ ] Single Proprietorship
[ ] Partnership or Joint Venture
[ ] Corporation
[ ] Cooperatives
[ ] Others ____________________________________________

SECTION 3. PROJECT DESCRIPTION


3.1

Project Description/Objectives: _______________________________________

EXPANSION CATEGORY
Check all applicable changes

[
[
[
[
[

]
]
]
]
]

Service capability
Area
Personnel
Equipment/Instrument
Physical plant

3.2

Project Cost for Expansion


Total Cost: [
]

3.3

Project Area
Attach Site Development Plan indicating the area of expansion if any.
Total Land Area (sq. meters or has.): __________________________
General Land Classification:
[ ] Public Land [ ] A & D
If public land, what classification:
[ ] Ancestral Land [ ] Reservation

] Others _________

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Status of Land Ownership :


[ ] owned/title by virtue of:
OCT or TCT # ______________________________
CLT/Emancipation Patent No. _____________________________
Free Patent No.
_______ _______________________________
Homestead Patent No. _______________________________
[ ] owned/untitled (tax declaration) _____________________________
[ ] stewardship contract: ______________________________________
[ ] lease: Lease Contract No. ___________________________________
[ ] others, pls. specify:
_____________________________

3.4

Project Location
Attach Location Map showing the project site in relation to important landmarks and
access points.

3.5

Project Components
1. Service Capability (for expansion)
( ) Administrative Service
( ) Clinical Service
( ) Nursing Service
2. Personnel (List number of personnel required for expansion)
____Administrative Service
____Clinical Service
____Nursing Service
3. Equipments/Instruments (Specify additional equipments/instruments for
Administrative, Clinical and Nursing Service required for expansion)
1.
2.
3.
4.
4. Physical Plant (for expansion)
( ) Administrative Service
( ) Nursing Service

3.6

) Clinical Service

Utilities and Infrastructures


Water Supply
Demand
Supply
What is the estimated daily water Can the existing water supply accommodate the
requirement
for
the
project demand for the proposed expansion?
expansion? _______cubic meters
[ ] Yes
[ ] No
If no, what will be used as an alternative source of

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water supply?
( ) rainwater collected in storage tanks
#of tanks
Capacity

_________
_________

( ) rainwater collected in reservoir


# of reservoirs _________
Capacity

_________

( ) deep well with manual or hand pump


# of pumps

________

( ) deep well with electric or motor pump


Capacity or Hp_________
( ) others, please specify _______________
Drainage System
Type of drainage:
Major roads: [
Other roads: [

] open canal
] open canal

[
[

] closed/underground drainage
] closed/underground drainage

Where does the drainage system drain?


[

] public drainage system

] natural outfall/water body

What water body (e.g. river, creek or stream) will serve as the outfall of the sewerage
and drainage systems? ________________________________
Where is this located? _________________________________________
Sewage Disposal System

Sewage System:
[

] Individual septic tank

] Communal septic tank

Sewage Design:
[
[
[
[
[
[

] 2-chamber septic tank w/ leaching


] 3-chamber septic tank w/ leaching
] 3-chamber septic tank w/o leaching
] 4-chamber septic tank w/ leaching
] 4-chamber septic tank w/o leaching
] others, pls. specify ______________________________________

Sewage Disposal :
[
[
[

] disposal to an existing public sewage system


] treated in a community disposal plant or communal septic tank
] treatment in individual septic tank with disposal by absorption

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field or leaching pit


] Others (specify) __________________________________________

Power Supply
Source of power supply for the expansion:
[
[
[

] Local Electric Cooperation: ___________________


] Own Generator
Capacity (HP) _____________
] Others, pls. specify ___________________________

3.7. Classification of Hospital Waste


Identify all wastes that shall be produced by the project expansion
Amount (tons/year)
[
[
[
[
[
[
[
[

] General waste
] Pathological waste
] Infectious waste
] Pharmaceutical waste
] Sharps waste
] Chemical waste
] Radioactive waste
] Others, pls. specify

_________________
_________________
_________________
_________________
_________________
_________________
_________________
_________________

3.8. Disposal of Hospital Waste

Collection system:
Will there be a hospital waste management system to be employed
prior to disposal?
[ ] Yes
[ ] No
If yes, state the process/procedure to be undertaken.

Disposal system
[
[
[
[

] Ecological solid waste management (e.g. composting)


] Open dumpsite outside of the project site
] municipal/city landfill area
] others _______________________________________

Location of the Hospital Waste Disposal Site: ___________________________


Frequency of disposal of hospital waste _______________________________
3.9. Operation and Maintenance
What operation and maintenance practices or procedures will be required for the
project expansion? ____________________________________________________
3.10 Manpower and Employment
How many will be employed by the project expansion? ___________

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3.11 Construction Schedule


How long will the pre-construction/construction period take? _______

SECTION 4.

4.1

DOCUMENTATION OF ENVIRONMENTAL PERFORMANCE AND


REGULATORY COMPLIANCE

Compliance to Environmental Rules and Regulations


Self Monitoring Reports
Attached Self Monitoring Reports of the last two quarters duly received by the DENREMB

4.2

Compliance to R.A. 4226: Hospital Licensure Act


Compliance to R.A. 4226: Hospital Licensure Act

Complying
Yes
No

Remarks

Planning and design of hospital


1. Readily accessible to the community ;

2. Location complying with local zoning


ordinances;
3. Provides and maintains a safe environment
for patients, personnel and public;
4. All areas are provided with sufficient
illumination and ventilation;
5. Observes acceptable sound level and
adequate visual seclusion;
6. Uses potable and adequate water supply;
7. Practices approved waste disposal;
8. Provides utilities for the maintenance of
sanitary system;
9. Separate toilet for personnel, mail and
female, with ratio of one (1) toilet for every
eight (8) patients or personnel;
10. Availability of fire detectors and fire
extinguishers in accessible areas;
11. Adequate and appropriate signage;
12. Adequate parking space;
13. Hospital areas are grouped according to
zones;
14. Different areas are functionally related with
each other;
15. Adequate area for the people, activity,
furniture, equipment and utility.
Service Capability*
[ ] Administrative Service
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Compliance to R.A. 4226: Hospital Licensure Act

] Clinical Service

] Nursing Service

] Ancillary Service

Complying
Yes
No

Remarks

Personnel*
[ ] Administrative Service
[

] Clinical Service

] Nursing Service

Equipment/Instrument*
[ ] Administrative Service
[

] Clinical Service

Physical Plant*
[ ] Administrative Service
[

] Clinical Service

] Nursing Service

*As prescribed in Annex 3 of DOH Administrative Order No. 70-A s. 2002


4.3

Community Relations
Is there a system identifying and responding to community and stakeholder concerns?
[ ] Yes
[ ] No
Is there a system for informing the community and other stakeholders on
environmental matters relative to the companys operations?
[ ] Yes
[ ] No

4.4

Complaints Management
Has the company/proponent received any complaints from the surrounding
community?
[ ] Yes
[ ] No
If yes, please specify: __________________________

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SECTION 5. ENVIRONMENTAL MANAGEMENT SYSTEM-BASED ENVIRONMENTAL


MANAGEMENT PLAN (EMS-based EMP) & ENVIRONMENTAL
MONITORING PLAN (EMoP)
Depending on the companys operation, proponent shall remove aspects not applicable to
their operation or add other aspects not identified in this table
ASPECT

AREA/ACTIVITY

Consumption
of water

Whole facility

Consumption
of energy

Production area

Use of paper

Admin/Office
area

Generation of
carton
boxes/plastics
and
other
packaging
materials
Generation of
(Specify)
hazardous
wastes
Generation of
domestic
wastewater
Others

(Specify)
production line

IMPACT

OBJECTIVES/TARGET

TOOLS/
RESOUCES

RESPONSIBLE
GROUP/
PERSON

Consumption
of natural
resources
Consumption
of natural
resources
Atmospheric
pollution
Consumption
of natural
resources
Consumption
of natural
resources
Land
contamination

(Specify)

Air, soil and


water
contamination

Whole facility

Soil and water


contamination

(Specify)

(Specify)

Approved by:

Prepared by:

Name and signature


Designation

Name and signature


Designation

ENVIRONMENTAL MONITORING PLAN (EMoP)


PARAMETER

LOCATION

FREQUENCY
OF
SAMPLING

METHODOLOGY

APPLICABLE
STANDARDS

RESPONSIBL
E PARTY

ESTIMATED
COST

AIR QUALITY
WATER
QUALITY
SOLID WASTE
TOXIC AND
HAZARDOUS
WASTE

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SECTION 7. PROPONENT'S COMMITMENTS

I/We, am/are committing to . . . . . . .


1. Comply with the following:

PD 984 Pollution Control Law


PD 1586 Philippine Environmental Impact Statement System
RA 6969 Toxic and Hazardous Waste Act of 1990
RA 8749 Clean Air Act of 1999
RA 9003 Ecological and Solid Waste Management Act of 2000
RA 9275 Clean Water Act of 2004 ; and

The implementing rules and regulations of the above-cited laws.


2. Comply with all mitigation/enhancement measures identified in this Checklist;
3. Construct, operate and maintain structures according to Building Code, Sanitation
Code and other applicable environmental rules and regulations of the Philippines
4. Establish adequate buffer zones within the project area
5. Immediately replace/ rehabilitate/ repair damaged structures/lines resulting from
natural or man-made calamities
6. Organize and conduct information, education and communication (IEC) activities on
safety and potential hazards of the project
7. Properly brief or orient the proponents staff about the ECC conditions, commitments
and agreements made about the project
8. Designate a Pollution Control Officer (PCO) to handle the environmental
management programs
9. Submit regular environmental monitoring reports to EMB RO, DENR
10. Strictly implement a contingency management plan and safety program.

__________________________________________

Signature over Printed Name


Managing Head

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ACCOUNTABILITY STATEMENT
This is to certify that all the information and commitments in this EPRMP Checklist /
Report are accurate and complete. Should we learn of any information which would make
this EPRMP inaccurate, I/we shall bring said information to the attention of the appropriate
EMB Regional Office, DENR.
We hereby bind ourselves jointly and solidarily to any penalty that may by imposed
arising from any misrepresentation of failure to state material information in this EPRMP
Checklist.
In witness whereof, we hereby set our hands this ______ day of ________ at
_________________.
_________________________
Project Proponent
________________________
Title or designation
ACKNOWLEDGMENT

BEFORE
ME
this
(day)
______________of
______________2006
_____________at _______________________________________,personally appeared
_________________________ with Community Tax Certificate No. _______ issued on
_________________
at
____________________,
in
his/her
capacity
as
______________________(designation)_________________at
___________________
and acknowledged to me that this EPRMP is his voluntary act and deed, and voluntary act
and deed
of the entity he/she
represents.
This document which consists of
_______________pages, including the page of which this acknowledgment is an EPRMP
Checklist/ Report.
Witness my hand and seal on the place and date above written.

____________________
Notary Public

Doc. No.
Page No.
Book No.
Series of

________________
________________
________________
________________

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