Annex C Safeguards Screening Form This form is to be used by the Implementing Agency (IA) to screen potential environmental and social safeguards issues in subprojects, and determine which safeguard instrument/s is to be prepared prior to implementation. Questions Answer If Yes Documents Required if WB Policy triggered Yes Yes No NA Are the project impacts likely to have significant adverse OP 4.01 Environmental Environmental Assessment environmental impacts that are sensitive, diverse or Assessment (EA) and Environmental unprecedented? Please provide brief description: Category A and Social Management Plan (ESMP) Do the impacts affect an area broader than the sites or facilities OP 4.01 Environmental EA and ESMP subject to physical works and are the significant adverse Assessment environmental impacts irreversible? Please provide brief Category A description: Is the proposed project likely to have no adverse environmental OP 4.01 Environmental Nothing further required impacts? Please provide brief justification. Assessment Category C Is the project neither a Category A nor Category C as defined by OP 4.01 Environmental EA or limited EA, and the Bank? Please provide brief justification. Assessment ESMP; Follow Category B Environmental of Practice (ECOPs) Are the project impacts likely to have significant adverse social OP 4.01 Environmental EA and ESMP impacts that are sensitive, diverse or unprecedented? Please Assessment provide description. Category A Will the project involve the discharge of pollutants into air, water, OP 4.01 Environmental ESMP with Hazardous soil and/or storage of chemicals, hazardous materials, etc that pose Assessment Materials Management risks to environmental and public health? Category B Plan Will the project site be located near rivers, waterways or water OP 4.01 Environmental EA or Limited EA and bodies/ponds? Assessment ESMP Category A/B Will the project adversely impact physical cultural resources? OP 4.11 Physical Cultural ESMP with PCR Please provide justification. Resources Management Plan and/or Category B Chance Find Procedures
Annex C Safeguards Screening Form This form is to be used by the Implementing Agency (IA) to screen potential environmental and social safeguards issues in subprojects, and determine which safeguard instrument/s is to be prepared prior to implementation. Questions Answer If Yes WB Policy triggered Documents Required if Yes Yes No NA Are the project impacts likely to have significant adverse environmental impacts that are sensitive, diverse or unprecedented? Please provide brief description: OP 4.01 Environmental Assessment Category A Environmental Assessment (EA) and Environmental and Social Management Plan (ESMP) Do the impacts affect an area broader than the sites or facilities subject to physical works and are the significant adverse environmental impacts irreversible? Please provide brief description: OP 4.01 Environmental Assessment Category A EA and ESMP Is the proposed project likely to have no adverse environmental impacts? Please provide brief justification. OP 4.01 Environmental Assessment Category C Nothing further required Is the project neither a Category A nor Category C as defined by the Bank? Please provide brief justification. OP 4.01 Environmental Assessment Category B EA or limited EA, and ESMP; Follow Environmental of Practice (ECOPs) Are the project impacts likely to have significant adverse social impacts that are sensitive, diverse or unprecedented? Please provide description. OP 4.01 Environmental Assessment Category A EA and ESMP Will the project involve the discharge of pollutants into air, water, soil and/or storage of chemicals, hazardous materials, etc that pose risks to environmental and public health? OP 4.01 Environmental Assessment Category B ESMP with Hazardous Materials Management Plan Will the project site be located near rivers, waterways or water bodies/ponds? OP 4.01 Environmental Assessment Category A/B EA or Limited EA and ESMP Will the project adversely impact physical cultural resources? Please provide justification. OP 4.11 Physical Cultural Resources Category B ESMP with PCR Management Plan and/or Chance Find Procedures
E47620EAP0ESMF0Box385451B00PUBLIC0.docx