Environmental Impact Assessment Checklist

Project Information

Project Title Location Proponent Date

Screening Questions

Item	Yes	No	Details/Comments
Will the project generate emissions or dust?
Will the project produce noise/vibrations?
Will the project affect water quality or availability?
Will the project disturb wildlife or habitats?
Does the project involve hazardous materials?

Potential Environmental Impacts

Describe any anticipated impacts on soil, air, water, flora, fauna, or local communities:

Mitigation Measures

List proposed measures to minimize, mitigate, or compensate for the above impacts:

Further Action

Is a detailed Environmental Impact Assessment required?