Environmental Management System Screening Form
ULG construction works project name:
Location (include map/sketch): (E.g. region, district, etc.)
Type of activity : (e.g. new construction,
rehabilitation, periodic maintenance)
Estimated Cost: (Birr)
Proposed Date of Works Commencement
Technical Drawing and Specifications (circle Yes No
Reviewed : answer):
This report is to be kept short and concise.
1. Site Selection:
Yes/No answers and bullet lists preferred except
Physical data:
where descriptive detail is essential.
Site area in ha
Extension of or changes to existing alignment
Any existing property to transfer to project
Any plans for new construction
Refer to project application for this information.
2. Impact identification and classification:
When considering the location of a ULG construction works project, rate the sensitivity of the proposed
site in the following table according to the given criteria. Higher ratings do not necessarily mean that a
site is unsuitable. They do indicate a real risk of causing undesirable adverse environmental and social
effects, and that more substantial environmental and/or social planning may be required to adequately
avoid, mitigate or manage potential effects. The following table should be used as a reference.
Site Sensitivity Rating
Issues
Low Medium High
Natural habitats No natural habitats present No critical natural habitats; Critical natural habitats present
of any kind other natural habitats occur
Water quality Water flows exceed any Medium intensity of water Intensive water use; multiple
and water existing demand; low use; multiple water users; water users; potential for
resource intensity of water use; water quality issues are conflicts is high; water quality
availability and potential water use conflicts important issues are important
use expected to be low; no
potential water quality issues
Natural hazards Flat terrain; no potential Medium slopes; some Mountainous terrain; steep
vulnerability, stability/erosion problems; no erosion potential; medium slopes; unstable soils; high
floods, soil known volcanic/seismic/ risks from volcanic/ erosion potential; volcanic,
stability/ erosion flood risks seismic/ flood/ hurricanes seismic or flood risks
Cultural property No known or suspected Suspected cultural heritage Known heritage sites in project
cultural heritage sites sites; known heritage sites area
in broader area of influence
Involuntary Low population density; Medium population High population density; major
resettlement dispersed population; legal density; mixed ownership towns and villages; low-income
tenure is well-defined; well- and land tenure; well- families and/or illegal ownership
defined water rights defined water rights of land; communal properties;
unclear water rights
Indigenous No indigenous population Dispersed and mixed Indigenous territories, reserves
peoples indigenous populations; and/or lands; vulnerable
highly acculturated indigenous populations
indigenous populations
3. Checklist of impacts
Roads, Drainage Bridge , Footpaths and Street
Potential for Adverse Impacts
lighting
None Low Med High Unknown
Soil erosion or flooding concerns (e.g., due to
highly erodible soils or steep gradients)
Number of stream crossings or disturbances
Wet season excavation
Creation of quarry sites or borrow pits
Significant vegetation removal
Wildlife habitats or populations disturbed
Be located within or nearby environmentally
Sensitive areas (e.g. intact natural forests,
Wetlands, e.t.c)?
Cultural or religious sites disturbed
Economic or physical resettlement required
New settlement pressures created
Create solid waste on the sites (including excess
fill materials from grading and excavation
activities, scrap wood and metals, and small
concrete spills)
Cause poor water drainage and increase the risk
of
water-related diseases such as malaria or
Bilharzias?
Cause air pollution? ( Fugitive dust, e.t.c)
Cause contaminated land?
Create Noise and vibration
Aesthetic disruption to the surrounding areas?
Cause Potential Physical hazards ( Like accident
or injury or illness due to repetitive exposure to
mechanical action or work activity)
Cause and spread communicable disease (poor
sanitation and, sexual transmission and vector-
borne infections)
Cause poor Water Quality and less water
Availability
Cause traffic congestion (Traffic accidents,
injuries and fatalities among members of the
Community )
Cause flood and gully formation at the outlet or
end point of drainage canals
An open ditch or drainage to be a waste bin that
could possibly become sources of microbial
breed, physical damage to humans and animals
Any right of way issues, impact on water lines,
telecommunication, electric poles and other
utility lines
Possible impact on individual’s property,
including impact on houses, fences and other
structures
Can cause more traffic accidents, since
pedestrian walk way is not properly considered
as part of the road design
Other (specify):
Potential for Adverse Impacts
Solid waste, liquid waste, toilet
None Low Med High Unknown
Risk of causing the contamination of drinking
water?
Number of stream crossings or disturbances
Natural hazards in flood
Significant vegetation removal
Soil erosion or flooding concerns (e.g., due to
highly erodible soils or steep gradients)
Wildlife habitats or populations disturbed?
Be located within or nearby environmentally
sensitive areas (e.g. residential & work areas,
intact natural forests, wetlands, e.t.c)?
Result in the production of solid or liquid waste,
or result in an increase in waste production,
during construction or operation?
Environmentally sensitive areas disturbed
Cultural or religious sites disturbed
Economic or physical resettlement required
New settlement pressures created
Cause contaminated land?
Increased number of toilet users due to
improvement?
Create Noise nuisance and vibration
Potential source of attraction for scavengers,
rodents and other animals
Increased social tension/conflict over toilet
allocation
Sanitation situation of public/communal toilets
because of lack of water supply and poor waste
management practices
Aesthetic disruption to the surrounding areas?
Cause Potential Physical hazards ( Like accident
or injury or illness due to repetitive exposure to
mechanical action or work activity)
Cause and spread communicable disease (poor
sanitation and, sexual transmission and vector-
borne infections)
Cause poor Water Quality and less water
Availability
Cause air pollution, contamination and bad
odour e.t.c
Cause traffic congestion (Traffic accidents,
injuries and fatalities among members of the
Community )
Possible impact on community health and safety
Cause any occupational health and safety issues
Risk of effluent quality for downstream
communities and environment
Other (specify):
Water supply Potential for Adverse Impacts
None Low Med High Unknown
New access (road) construction
Existing water sources supply/yield depletion
Existing water users disrupted
Downstream water users disrupted
Potential conflict between downstream and
upstream or beneficiary communities
Increased numbers of water users due to
improvements
Increased social tensions/conflict over water
allocation
Sensitive ecosystems downstream disrupted
Economic or physical resettlement required
Local incapacity/inexperience to manage facilities
Cause contaminated land?
Create Noise and vibration
Aesthetic disruption to the surrounding areas?
Cause Potential Physical hazards ( Like accident
or injury or illness due to repetitive exposure to
mechanical action or work activity)
Cause and spread communicable disease (poor
sanitation and, sexual transmission and vector-
borne infections)
Cause poor Water Quality and less water
Availability
Possible contamination of water sources by
anthropogenic or natural events
Block of access and routes or disrupt normal
operations in the general area
Will the project generate solid or liquid wastes?
(Including human excreta/sewage, hospital waste
Historical, archaeological or cultural heritage site
Presence of wet lands in close proximity to the
water supply sources
Any health and safety related risks
Create a risk of increasing soil salinity?
Cause traffic congestion (Traffic accidents,
injuries and fatalities among members of the
Community )
Other (specify):
Integrated multiple infrastructure & services Potential for Adverse Impacts
to land for housing, MSE & industrial
development None Low Med High Unknown
Soil erosion or flooding concerns (e.g., due to
highly erodible soils or steep gradients)
Number of stream crossings or disturbances
Wet season excavation
Creation of quarry sites or borrow pits
Significant vegetation removal
Wildlife habitats or populations disturbed
Environmentally sensitive areas disturbed
Cultural or religious sites disturbed
Economic or physical resettlement required
Cause contaminated land?
Cause air pollution? ( Fugitive dust, e.t.c)
Create Noise and vibration
Aesthetic disruption to the surrounding areas?
Cause Potential Physical hazards ( Like accident
or injury or illness due to repetitive exposure to
mechanical action or work activity)
Cause and spread communicable disease (poor
sanitation and, sexual transmission and vector-
borne infections)
Cause poor Water Quality and less water
Availability
Create a risk of increasing soil salinity?
Cause traffic congestion (Traffic accidents,
injuries and fatalities among members of the
Community )
Risk of causing the contamination of drinking
water?
Cause poor water drainage and increase the risk
of
Water-related diseases such as malaria or
bilharzias?
Produce, or increase the production of, solid or
liquid wastes (e.g. sewage wastewater, medical,
and domestic or construction wastes)?
New settlement pressures created
Result in the production of solid or liquid waste,
or result in an increase in waste production,
during construction or operation
Possible contamination of water sources by
anthropogenic or natural events
Block of access and routes or disrupt normal
operations in the general area
Presence of wet lands in close proximity to the
water supply sources
Any health and safety related risks
Affect the quantity or quality of surface waters
(e.g. rivers, streams, wetlands), or groundwater
(e.g. wells)?
Other (specify):
Urban Greenery Infrastructure Potential for Adverse Impacts
Impacts during construction, operation and
phases. None Low Med High Unknown
Soil erosion or flooding concerns (e.g., due to
highly erodible soils or steep gradients)
Environmentally sensitive areas disturbed?
Require that land (public or private) be acquired
(Temporarily or permanently) for its
development?
Use land that is currently occupied or regularly
used for productive purposes (e.g. gardening,
Farming, pasture, fishing locations, forest)?
Displace individuals, families or businesses?
Result in temporary or permanent loss of crops,
fruit trees or household infrastructure such as
Granary, outside toilets and kitchens?
Result in involuntary restriction of access by
people to legally designate parks and protected
areas?
Disturbance of economic activities leading to loss
of property or income?
Cultural or religious sites disturbed?
Cause poor water drainage and increase the risk
of
Water-related diseases such as malaria or
bilharzias?
Produce, or increase the production of, solid or
liquid wastes (e.g. sewage wastewater, medical,
and domestic or construction wastes)?
Affect the quantity or quality of surface waters
(e.g. rivers, streams, wetlands), or groundwater
(e.g. wells)?
Result in the production of solid or liquid waste,
or result in an increase in waste production,
during construction or operation?
Cause Potential Physical hazards ( Like accident
or injury or illness due to repetitive exposure to
mechanical action or work activity)
Cause and spread communicable disease (poor
sanitation and, sexual transmission and vector-
borne infections)
Cause poor Water Quality and less water
Availability
Cause traffic congestion (Traffic accidents,
injuries and fatalities among members of the
Community )
Any other health and safety related matters
Other (specify):
General questions that applies for all types of subprojects
1. Preliminary Environmental Information: Yes/No answers and bullet lists preferred except
where descriptive detail is essential
State the source of information available at this stage (ULG
report, , site observation, stakeholders’ consultation, ESIA or
other environmental study).
Has there been litigation or complaints of any environmental
nature directed against the proponent or ULG construction
works project
Refer to application and/or relevant environmental authority for this information
2. Identify type of activities and likely environmental impacts: Yes/No answers and bullet
lists preferred except where descriptive detail is essential
What are the likely environmental impacts, opportunities,
risks and liabilities associated with the project
Refer to ESMS– Impact, Mitigation and Monitoring Guidelines
3. Determine environmental screening category: Yes/No answers and bullet lists preferred
except where descriptive detail is essential.
After compiling the above, determine which category the
ULG construction works project falls under based on the
environmental categories 1, 2 and 3.
Refer to ESMSG – Screening and Review Process
4. Mitigation of Potential Pollution: Yes/No answers and bullet lists preferred except where
descriptive detail is essential
Does the ULG construction works project have the potential
to pollute the environment, or contravene any environmental
laws and regulations?
Will the ULG construction works project require pesticide
use?
If so, then the proposal must detail the methodology and
equipment incorporated in the design to constrain pollution
within the laws and regulations and to address pesticide use,
storage and handling.
Does the design adequately detail mitigating measures?
Refer to ESMS– Impact, Mitigation and Monitoring Guidelines
5. Environmental Assessment Report or environmental studies required: Yes/No answers
and bullet lists preferred except where descriptive detail is essential
If Screening identifies environmental issues that require
further an ESIA or a study, does the proposal include the
ESIA, PESIA, ESMP, CPMP, RAP or any other types study?
Indicate the scope and time frame of any outstanding
environmental study.
Required Environmental Monitoring Plan:
If the screening identifies environmental issues that require
long term or intermittent monitoring (effluent, gaseous
discharges, water quality, soil quality, air quality, noise etc.),
does the proposal detail adequate monitoring requirements?
6. Public participation/information requirements: Yes/No answers and bullet lists preferred
except where descriptive detail is essential
Does the proposal require, under national or local laws, the
public to be informed, consulted or involved?
Has consultation been completed?
Indicate the time frame of any outstanding consultation
process.
Categorization & Recommendations*
Category
Schedule 1 Project to be fed into the standard ESIA process determined by MEF
Schedule 2 Project will not require an ESIA, but will necessitate the inclusion of
environmental and social mitigation and enhancement measures in
the design and implementation of the project through the use of
standard construction contract clauses and an environmental
management plan
Schedule 3 Project is not subject to environmental assessment as no potential
impacts are anticipated.
*Place tick in applicable box
Prepared by Name:
Signature:
Date:
Reviewed by Name:
Signature:
Date:
