3: ENVIRONMENTAL SCREENING School and Teacher/Student facilities Construction This form has to be filled by authorities or school committee Instructions: I. General Information 1. Name of village, commune and province 2. Name of proposed project 3. Type of project New construction Reconstruction □ □ Rehabilitation Other (please specify) □ □ 4. Objective of the proposed project and brief description Please check ( ) √ 5. Does the proposed project involve all types and classes of the people in the □ □ □ locality? II. Environmental 1. Does the project located in the land mine or UXO area? □ □ □ Checklist (please check the box where 2. Is there any cultural heritage area nearby the propose project? □ □ □ appropriate) 3. Is there any mortuary site in or near the proposed project area? □ □ □ 4. Does the project’s implementation interrupt the natural flow of canal or any □ □ □ stream? 5. Does the project’s implementation increase the possibility of ground water □ □ □ pollution?
3: ENVIRONMENTAL SCREENING School and Teacher/Student facilities Construction Instructions: This form has to be filled by authorities or school committee I. General Information 1. Name of village, commune and province 2. Name of proposed project 3. Type of project New construction □ Reconstruction □ Rehabilitation □ Other (please specify) □ 4. Objective of the proposed project and brief description Please check ( √ ) 5. Does the proposed project involve all types and classes of the people in the locality? □ □ □ II. Environmental Checklist (please check the box where appropriate) 1. Does the project located in the land mine or UXO area? □ □ □ 2. Is there any cultural heritage area nearby the propose project? □ □ □ 3. Is there any mortuary site in or near the proposed project area? □ □ □ 4. Does the project’s implementation interrupt the natural flow of canal or any stream? □ □ □ 5. Does the project’s implementation increase the possibility of ground water pollution? □ □ □
SFG2702-EA-P157858-Box396335B-PUBLIC-Disclosed-11-30-2016.docx