Social Fund for Development Environmental Management Plan


Annex (4) Environmental Screening Form ( B)



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Annex (4)

Environmental Screening Form ( B)


Environmental Screening Form (B)



1. Projects Name: ____________________________________________________

2. Project's Type (health care, educational, water, environment, other utilities) _____________________________________________________________________
3. Brief description of the project (project's components including assisting services, scope of service, number of beneficiaries, number of workers … etc) _______________________________________________________________________________________________________________________________________________________________________________________________________________

4. Brief description of the project's location (nature of location: rocky or dusty, the previous usage of the location):

__________________________________________________________________________________________________________________________________________



5. Description of the surrounding area: for a circle of 50 meters radius from the drainage point, specially locations of environmental sensitivity (utilities, constructions, land usage, water sources (1 ) … etc).

(Sketch drawing of the of the project)



6. Environmental Impacts & Mitigation Measures * (Construction & Operation Phase)


Project's Phase

Parameter

Influencing Factor

Mitigation Measure

Institution Responsible for Execution

Design





































Construction


























Operation

















































* Example for design phase: Parameter: Water, influencing factor: Disposal of wastewater, mitigating measure: design proper wastewater treatment, Responsibility: Consultatant

7. Does the project need monitoring during its operation ? (in case there is a probability of polluting water resources, or soil or air) yes  No 

8. In case the answer is yes, mark the monitoring issues applicable to your project:

 Monitoring water sources

 Monitoring the performance of health care waste disposal

 Monitoring the performance of sanitary drainage system

 Monitoring the cleanness of the building's yard

 Monitoring the planting of trees in the building's yard



Table for Environmental monitoring during project operation


Parameter

Indicator

Location

No. of samples

Intervals

Responsibility









































































Example: Parameter: Water, Indicator: Nitrate, Location: Albaraka well, No of samples: 4, Interval: one year, Responsibility: SFD



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