Azerbaijan republik

ANNEX 2. ENVİRONMENTAL SCREENING CHECKLIST FORMS.

Environmental Screening Checklist forms shall be prepared by credit/grant applicants and will be included in the credit/grant application forms.

FORM 1 - ENVIRONMENTAL SCREENING CHECKLIST

(To be completed by credit/grant applicant)
1. Sub-project name:

_____________________________________________________________________________
2. Brief Description of Sub-project: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.1 Nature of the activity: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.2 Cost: ________________________________________________________________________
2.3 Physical characteristics (biology, soil, water resources of sub-project site): ________________________________________________________
2.4 Site area:_____________________________________________________________________
2.5 Location: _____________________________________________________________________
2.6 Property ownership:____________________________________________________________
2.7 Existence of ongoing operations?_________________________________________________
2.8 Plans for Expansion of Ongoing Opertions?___________________________________________________________
2.9 New construction with project funds?______________________________________________________________

3. Will the Sub-project have impacts on the environment as listed below? Indicate with a check, which impacts are likely to occur and whether mitigation measures are required by completing the appropriate sections below.

Table A-2.1 Farm Inputs Screening Checklist

Input	Potential Impact	Mitigation Measures needed/to be identified
		Yes	No
Seed	Water and soil contamination through chemical inputs: Yes____ No______
Pedigree seed	Biodiversity loss: Yes___ _No_____ Chemical inputs: Yes___ No_____
Fertilizer	Water pollution: Yes__ _ No_____
Pesticides	Ill health: Yes_____No____ Water pollution: Yes_____No_____ Soil contamination: Yes____No_____
Pedigree animals	Water and soil pollution by animal wastes: Yes____No_____
Animals for finishing	Overgrazing: Yes_____No___ Forest degradation: Yes____ No___
Land preparation (tractor and machinery hire)	Soil erosion: Yes_____No_____
Tractors	Soil compaction and erosion: Yes_____No____
Other farm implements	None
Small equipment	None
Irrigation equipment and irrigation maintenance	Water extraction and salinization Yes_____No_____
Primary processing equipment	Water pollution: Yes_____No_____
Veterinary Services	Hormones and chemicals in meat: Yes____No___
Laboratory testing	Water and soil contamination through chemical and biological inputs: Yes____ No______

Table A -2.2: Agricultural Enterprise Screening Checklist

Broad Category	Potential Impact			Mitigation measures
		Yes	No	Yes	No
Agro-processing	water pollution safety and health biophysical and cultural losses through location
Market refurbishment of new market structure	Poor location disrupting people and perhaps important biophysical and cultural resources
Agriculture equipment hire	Soil erosion and soil compaction as result of farm mechanization
Irrigation systems	Desertification and depletion of water resources
Other agribusiness	Variety of minor impacts although aquaculture could result in damage to aquatic ecosystems, particularly the loss of endemic fish species
Agrotourizm, ecotourism	Location: biophysical losses aesthetics construction impacts water pollution

4. For the environmental components that were indicated above with a check, describe the mitigation measures that will be included during the construction (C) or operational (O) phase of sub-project or both (B)

Table A- 2.3: Environmental Mitigation Plan

Environmental component (What is to be mitigated)	Sub-project Phase (C, O or B)	How and where will it be mitigated	Responsibility and cost

FORM 2 – ENVIRONMENTAL SCREENING CHECKLIST

(To be completed by VCDS/PFI)
1. Sub-project name: _____________________________________________________________
2. Environmental Category (A, B or C): _____________________________________________
3. Environmental assessment required: _____________________________________________
4. What environmental issues raised by the sub-project: ___________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________
5. If an environmental assessment is required, what are the specific issues to be addressed: ___________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________
6. What is the time frame and estimated cost of conducting the environmental assessment? _____________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________

FORM 3 – FIELD VISIT CHECKLIST

(To be completed by VCDS/PFIs)

Project Name: Date/time of Visit:

Raion: Visitors:
Location

• 
  Obtain a site map or make a sketch
  
• 
  Locate site on local map or indicate area (e.g. for grazing)
  

Current activity and site history

• 
  Who is the site contact (name, position, contact information)?
  
• 
  What is the area of the site to be used for project activities?
  
• 
  What are current uses of the site?
  
• 
  What were previous uses of the site (give dates if possible)?
  

Environmental Situation

• 
  Are there sensitive sites nearby (nature reserves, cultural sites, historical landmarks)?
  
• 
  Is anything known about the geology/hydrology of the site? Are there water courses on the site?
  
• 
  What is the terrain or slope?
  
• 
  Does the site experience flooding, waterlogging or landslides? Are there signs of erosion?
  
• 
  What are the neighboring buildings ( e.g. schools, dwellings, industries) and land uses? Estimate distances.
  
• 
  Will the proposed site affect transportation or public utilities?
  

Licenses, Permits and Clearances

• 
  Does the site require licenses or permits to operate the type of activity proposed? Are these available for inspection?
  
• 
  What environmental or other (e.g., health, forestry) authorities have jurisdiction over the site?
  

Water Quality Issues

• 
  Does the proposed activity use water for any purposes (give details and estimate quantity). What is the source?
  
• 
  Will the proposed activity produce any effluent? (estimate quantity and identify discharge point)
  
• 
  Is there a drainage system on site for surface waters or sewage? Is there a plan available of existing drainage or septic systems?
  
• 
  How waste water is managed (surface water courses, dry wells, septic tanks)?
  

Soils

• 
  What is the ground surface (agricultural land, pasture, etc.)?
  
• 
  Will the project damage soils during construction or operations?
  
• 
  Will the project affect the landscape significantly (draining wetlands, changing stream courses)
  

Biological environment

• 
  Describe vegetation cover on the site.
  
• 
  Is there information about rare or threatened flora and fauna at or near the site? If yes, would the project have an impact or increase risk to the species?
  
• 
  Obtain a list of vertebrate fauna and common plants of the site (if available).
  
• 
  Note potential negative impacts on biota if project proceeds.
  

Visual Inspection Procedures

• 
  Try to obtain a site map or make a sketch to mark details.
  
• 
  Take photos, if permitted.
  
• 
  Walk over as much of the site as possible, including boundaries, to note adjacent activities.
  
• 
  Note any odors, smoke or dust emissions, standing water, etc.