CEMETERY, FUNERAL PARLORS, CREMATORIUM, AND COLUMBARIUM PROJECTS

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT

For

Project name or Title

This IEE Checklist Report shall be used for proposed CEMETERY, FUNERAL PARLORS,
CREMATORIUM, AND COLUMBARIUM PROJECTS to be located within Environmentally
Critical Areas (ECA).
Please check applicable project category:
Projects Project Size Corresponding Project
9 Parameter Size/Threshold
Cemetery area to be ≥ 5.0 hectares
developed
total/gross floor ≥ 1 hectare
Funeral parlors, crematorium, area including
columbarium parking and other
areas
For ECC applications, this IEE Checklist Report shall be submitted with:
• Proof of Compatibility with the existing Land Use Plan
• Proof of Authority over the Project Site
• Accountability Statements of Proponent (see attached form) and the Preparer (if any,
following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)
• Photographs or plates/vicinity map of the project site showing impact areas and affected
areas and communities
• Duly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme
(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)
(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 (a) 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 proponents are strongly discouraged to engage the

services of consultants/facilitators/preparers to accomplish/fill-up
the IEE Checklist Report Form. The Report Forms have been
designed to be user-friendly.

Furthermore, EMB Regional Office is required to complete the

processing of an ECC application using the IEE Checklist Report
within twenty (20) working days upon receipt for completed/duly-
accomplished form.

Misleading or erroneous answers are basis for legal actions and/or denial of ECC
issuance.

PROJECT FACT SHEET

Project Name: _______________________________________________________

Project Location: _______________________________________________________

Total Project Land Area: _______________________________________________________

Total Project/Building _______________________________________________________

 Footprint Area
(Area actually utilized)
Project Proponent: _______________________________________________________
Office Address: _______________________________________________________
Contact Person: _______________________________________________________
Designation: _______________________________________________________
Contact Number/s
Landline : _______________________________________________________
Fax Number: _______________________________________________________
Mobile : _______________________________________________________
E-mail Address: _______________________________________________________

I. PROJECT DESCRIPTION

1.1 PROJECT LOCATION AND AREA: Street Name, Barangay, and Municipality/City, Province

__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________

Attach vicinity map/s and photographs of the project site and site development/layout plan.

Geographic coordinates of the project area (Preferably use WGS 84 datum, otherwise specify datum used).
Perimeter/Boundary points
Longitude Latitude
(based on OCT/TCT/etc)

1.2 PROJECT COMPONENTS

Cemetery and Funeral Homes

Facilities No. of Units Area (sq. m.) / Specification/

Capacity Description / Remarks

1. Area for internment, vaults,

columbarium, etc.
2. Commercial Area (e.g.
restaurants, food outlets, etc.)
3. Crematorium
4. Wake Chapel, viewing area,
and similar facilities
5. Support facilities (e.g. morgue,
embalming facility, showroom,
etc.)
6. Amenities (e.g. rest room, etc.)
7. Open/Common Spaces (e.g.
reception area, garden, parks,
etc.)
8. Parking area
9. Waste water Management
Facility
10. Solid waste management
facilities
11. Drainage System
12. Others, specify
_____________________
 (Use additional sheets if needed)
_____________________________________________________________________________________

1.3 UTILITIES/REQUIREMENTS (Operation Phase):

Utilities Source Estimated Demand/Consumption

Power/Electricity KWh
(Total)
Power/Electricity KWh
(From Renewable Energy
Sources)
Water m³/day
(Total)
(Fill-up table below if water is
not obtained from the local
water utility)
Water m³/day
(Rainwater Collection
System)

Water Source
[ ] ground water [ ] well [ ] spring [ ] others: ____________________________

[ ] Surface water [ ] river [ ] lake [ ] others: ____________________________

Location of water source

____________________________________________________________________________
(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh

Water m³/day

1.4 MANPOWER

a. Construction Phase
Manpower Expertise/Skills Total
Requirement

b. Operation Phase
Manpower Expertise/Skills Total
Requirement

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

 II. ENVIRONMENTAL IMPACTS AND MANAGEMENT PLAN

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
LAND
; Consistency with land Current land use w/in 1km radius ; See attached proof of compatibility with
use (as per zoning ordinance): land use
Residential
Commercial/ Institutional
Industrial
Agricultural/ Recreational
Protected Areas
Others, specify
___________________

Actual land uses w/in 1km radius:

Residential
Commercial/ Institutional
Industrial
Agricultural/ Recreational
Protected Areas
Others, specify
___________________

Disturbance to wildlife Existing vegetation in the area: ; Compliance with conditions of DENR/LGU ; Annual inspection of area ; Cost integrated in the
due to vegetation Forestland SLUP, Tree Cutting Permit, ROW, PCA replanted/ revegetated construction /operation cost
Permit
clearing Marshland
Grassland
; Limit land clearing as much as possible

Mangrove
; Provide temporary fencing for vegetation
that will be retained
Wetland ; Promote restoration of damaged or
Others, specify destroyed vegetation where possible (e.g.,
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
____________________ tree planting);

Change in surface Slope: Provide erosion control and slope Regular inspection of slope Slope/ Erosion Control
landform/ topography/ flat (0-3%) protection measures protection measures in Cost: ___________
terrain/slope gently sloping to rolling (3-18%) Designate a Spoils Storage Area, with erosion-prone areas Others, specify
steep (>18%) topsoil set aside for later use and allow Regular inspection for new ____________
Soil Erosion maximum re-use of spoils eroded areas near the site
Construction during dry season Others, specify
Stabilization of embankment with grasses ___________
or other soil cover
Others, specify
____________

Is the project site located in an area Compliance with the DENR Administrative
identified by MGB/PAG-ASA/ Order No. 2003-30 and DENR
PHIVOLCS as hazard prone? Administrative Order No. 2000-28,
Yes Implementing Guidelines on Engineering
Geological and Geo-hazard Assessment
No (EGGA).
; Soil/Land contamination Existing soil type in the area: ; Implementation of the Ecological Solid ; Daily inspection of ; Cost integrated in the
due to improper solid sandy Waste Management Plan (ESWMP) waste/recycling bins for construction /operation cost
waste disposal
clay Set-up temporary fence around the segregation

sandy-loam
construction area ; Daily inspection for presence
; Implement re-use and recycling of waste of mixed garbage in the
Others, specify
materials facility
________________ ; Weekly inspection of waste
; Implement proper segregation, collection
and disposal of domestic wastes in accumulated
designated areas Others, specify
Implement proper collection, labeling and _____________________
storage of hazardous waste
; Provide receptacles / bins for solid wastes
Coordinate with the municipal / city waste
collectors
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Engage third party company for waste
collection
Others, specify
________________

Impairment of Presence of visually significant

landforms/landscape/structures?
Implement landscaping and other Regular inspection of ; Cost integrated in the
visual aesthetics beautification measures landscaping and other construction/ operation cost
Devaluation of land Yes Provide adequate buffer beautification activities
values No Compensate adjacent property owners Regular monitoring of buffer
zones
Others, specify
; Regularly monitor
________________
presence/absence of
complaints from adjacent
property owners
WATER

Increased siltation due Specify nearest/receiving water ; Set-up proper and adequate sanitary Regular (ocular) inspection of: ; Cost integrated in the
to project activities body:
____________________________
facilities Drainage / canal systems construction/ operation cost
Water quality __ Strictly require the contractor and its Water treatment facility (i.e.,
degradation workers to observe proper waste disposal grease trap, septic tank, etc.)
and proper sanitation
Others, specify Distance to nearest/receiving water
_________________ body: ; Strictly observe proper waste handling and Regular (ocular) inspection of
disposal waterbody for:
0 to less than 0.5 km
0.5 to 1 km
Provision of wastewater treatment facility Turbidity and/or silted
(e.g. septic tank, oil and water separator, condition
More than 1 km etc.) Floating wastes or debris
If nearest/receiving water body is
Set up silt trap/stilling ponds to minimize
downstream siltation
fresh water, specify classification:
AA
Others, specify
___________
A
B
C Provision of three-chambered septic tank
for domestic sewage
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
D

If nearest/receiving water body is

coastal or marine water, specify
classification:
SA
SB
SC
SD

Current Water Use:

Fishery
Tourist Zone / Park
Recreational
Industrial
Agricultural

Distance of project area to the

nearest well used:
0 to less than 0.5 km
0.5 to 1 km
More than 1 km

Use of the nearest well:

Drinking/Domestic
Industrial
Agricultural
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

Competition in water Size of population using receiving Implement rainwater harvesting and similar ; Cost integrated in the
use surface water: measures as an alternative source of water ; Regularly monitor construction/ operation cost
Depletion of water ≤ 1,000 persons Observe water conservation measures;
presence/absence of
complaints
resources >1,000 and ≤ 5,000persons Others, specify
>5,000person ____________________
; Regular coordination with
concerned agencies
Available/nearest water source. ; Regularly monitor
occurrences of water
Deepwell shortages
Water district/LGU Others, specify
Surface water ________________
Others, specify
___________________

Increased occurrence Is the project site located in an area

identified by MGB/PAG-ASA as
Use appropriate design for project facilities ; Regularly monitor ; Cost integrated in the
presence/absence of construction/ operation cost
of flooding
flood prone? Implement appropriate drainage system
complaints
Yes Regularly remove debris and other
; Regular coordination with
materials that may obstruct water flow
No concerned agencies
Others, specify ; Regularly monitor increased
___________________ frequency of flooding
Others, specify
_________________

AIR / NOISE

Air quality degradation Distance to nearest community: Properly operate and maintain all emission ; Regularly monitor ; Cost integrated in the
0 to less than 0.5 km sources (e.g. generator, etc) presence/absence of construction/ operation cost
complaints
0.5 to 1 km Install when applicable, the appropriate air
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
More than 1 km pollution control device/s Regular (ocular) inspection of:
Strictly enforce good housekeeping Absence of white or black
practices smoke from vehicles
Other, specify
_______________________

PEOPLE

Displacement of Provide relocation/disturbance ; Regularly monitor ; Cost integrated in the

residents in the project compensation packages presence/absence of construction/ operation cost
site and within its Size of population of host barangay: ; Prioritize local residents for employment complaints
vicinity
≤ 1,000 persons ; Promptly pay local taxes and other ; Regular coordination with
Displacement of
>1,000 and ≤ 5,000persons financial obligations LGU
Indigenous People
>5,000person ; Regular coordination with LGU Others, specify
Enhanced
Prior consultation & coordination to
_________________
employment and/or
Classification of host barangay: minimize disruption on daily domestic
livelihood
opportunities Urban activities & respect for IP rights and
cultural practices
Reduced Rural
Ensure participation of IPs in
employment and/or
Available services within/near the consultations and dialogues
livelihood
opportunities host barangay: Provide appropriate traffic/warning
Increased revenues Schools (e.g. elementary, high signs, lighting, etc
for LGU school, college) Others, specify
Disruption/Competit Health facilities (e.g., clinics, _________________
ion in delivery of hospitals, etc.)
public services Peace and order (e.g., police
(e.g., education, outpost, brgy. Tanod, etc.)
peace and order,
etc.)
Recreation and sports facilities

Enhanced delivery
Others, specify
_________________
of public services
(e.g., education,
peace and order,
etc.)
Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
Increase in traffic
volume and worsening
of traffic flow

Impacts on community ; Regular coordination with LGU ; Regularly monitor ; Cost integrated in the
health and safety Provide appropriate warning signs, lighting presence/absence of
complaints
construction/ operation cost
Others, specify and barricades, whenever practicable
_________________ ; Observe proper housekeeping ; Regular coordination with
LGU
Provide on-site medical services for any
; Regularly monitor submission
emergency.
of reports to concerned
Participate in public awareness programs agency
on health and safety
Others, specify
_________________
Others, specify
________________________
III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND
GENERIC GUIDELINES (if Applicable)

Project Life or Service: ___________ years

Provide description of the Abandonment activities, such as, dismantling and waste
disposal.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION

Organization Chart:

4.1. Abandonment Plan (if Applicable)

Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)
 SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT

This is to certify that all the information and commitments in this Initial Environmental
Examination (IEE) Checklist Report are accurate and complete to the best of my knowledge.

By the authority vested in me by the __ (Company Name) as

___(Position/Designation), I hereby commit to ensure implementation of all commitments,
mitigating measures and monitoring requirements indicated in this IEE Checklist Report as
well as the following:
• Conform to pertinent provisions of applicable environmental laws e.g., R.A.
No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act
of 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),
R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749
(Philippine Clean Air Act of 1999).
• Abide and conform to LGU development plan and guidelines.
• Promptly pay local taxes and other financial obligations.
• Regularly submit reports to concerned agencies.

I hereby bind myself to answer any penalty that may be imposed arising from any
misrepresentation or failure to state material information in this IEE Checklist.

In witness whereof, I hereby set my hand this ____ day of __________ at

______________________.

__________________________
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 ____________________