Project Information
Project Name
Project Location
Proponent/Organization
Assessment Date
Habitat Description
Habitat Type
Dominant Species
Habitat Condition
Ecological Significance
Potential Wildlife Impacts
Wildlife Species Potentially Affected
Description of Potential Impacts
Impact Severity
Low
Moderate
High
Mitigation Measures
Proposed Mitigation Measures
Assessment Summary
Summary & Recommendations
Name of Assessor
Signature