Environmental and Social Management Framework (esmf)

Annex 3. Environmental Screening Checklists

Form 1 (to be completed by subproject applicant/beneficiary)

1. 
   Sub-Project Name:
   
2. 
   Brief Description of Sub-project to include: nature of the project, project cost, physical size, site area, location, property ownership, existence of on-going operations, plans for expansion or new construction (the description can be copied from the subproject proposal and attached)
   
3. 
   Will the project have impacts on the environmental parameters listed below during the construction or operational phases? Indicate, with a check, during which phase impacts will occur and whether mitigation measures are required.
   
4. 
   Project Environmental Risk Category _____
   
5. 
   ESMP required (yes or no) _____
   
6. 
   Specific issues to be addressed in the ESMP?
   

Environmental Screener: Date: