Project Name:

[Project Name]

Property Address:

[Property Address]

Land Use

Will the proposed development require clearing of vegetation or natural habitats?

• Yes

• No

Will the development affect local land use patterns?

• Yes

• No

Air Quality

Are there potential sources of air pollution during construction?

• Yes

• No

Will ongoing operations impact local air quality?

• Yes

• No

Water Resources

Is there potential for increased runoff and erosion during construction?

• Yes

• No

Will the development impact nearby water bodies or aquifers?

• Yes

• No

Noise and Vibration

Are expected noise levels during construction activities significant?

• Yes

• No

Will ongoing operational activities affect noise levels in the area?

• Yes

• No

Wildlife and Habitat

Are there endangered species or sensitive habitats present on or near the site?

• Yes

• No

Will the development impact wildlife migration patterns?

• Yes

• No

Socio-Economic Impacts

Are there potential effects of the development on local employment opportunities?

• Yes

• No

Will property values in the surrounding area be affected by the development?

• Yes

• No

Cultural Heritage

Are there known archaeological sites or cultural heritage resources on the site?

• Yes

• No

Will the development impact historic structures or traditional land uses?

• Yes

• No

Hazardous Materials

Are there hazardous materials present on the site that could pose risks during construction?

• Yes

• No

Will the development introduce any new hazardous materials into the environment?

• Yes

• No