5. Applicant Questionnaire on Environmental Issues
ASEP 2009 Request for Proposals Application Package
Instructions for completing the Applicant Questionnaire on Environmental Issues
You can copy and paste the required form information below into a word processor, provide the appropriate information, print, sign and send by mail.
Note to applicant:
Please complete this questionnaire in detail and return it with your application.
Your responses to this questionnaire, along with your completed application form, will help determine if an environmental assessment of your proposal is required in accordance with the Canadian Environmental Assessment Act.
Required Form Information for the Applicant Questionnaire on Environmental Issues
Applicant name:
Program:
Proposal title:
1. Will you apply or have you applied to any other federal department or agency for funding, permits, or authorizations or for the use, lease, or sale of federally regulated or crown lands(s) related to this project?
Yes (complete the table below) or No
Department:
Nature of department's involvement in project:
Phone number:
Contact name:
2. Has an environmental assessment of this project been done or is one in process?
Yes or No:
If yes, please provide a copy of the environmental assessment report completed for this project. If a copy of the report is not available from you or is in the process of being produced, indicate the name, address, and telephone number of the individual we can contact for a copy.
Contact information:
3. Will the project activities involve construction, operation, modification, decommissioning, or abandonment of any building, structure, trail, park, facilities, etc.?
Yes or No:
If yes, provide details, sketches, design details, appropriate maps, etc.
4. Will the project occur in, on, or within 30 metres of any water body or wetland?
Yes or No:
If yes, provide details, sketches, design details, appropriate maps, etc.
5. Is there any chance this project could release any polluting substance into a water body or wetland during construction and/or after the project begins operation? (for example, silting, chemicals, waste, disposal of materials, etc.)
Yes (specify) or No:
6. Does the project involve the cleanup, storage, handling, use, or disposal of potentially hazardous materials? (for example, chemically-treated wood, lead-based paints, PCBs, HCFs, CFCs, asbestos, fibreglass, dusty conditions in an old building [if concern is warranted i.e. lack of information on dust content, significant accumulation of dust], oil or gas tanks, resins, toxins, pesticides, fertilizers, caustic substances, etc.)
Yes (specify) or No:
7. Will heavy equipment be used during construction of the project or once the project is operational?
Yes or No:
If yes, describe the type of equipment and what it will be used for (for example, a bulldozer to level two acres of land).
8. Does your project occur in an undeveloped area?
Yes or No:
If yes, will there be cutting or removal of trees or shrubs from an area greater than 1,000 square metres, or clearing or removal of all vegetation from an area greater than 500 square metres?
9. Has the public been consulted or are there plans to consult the public regarding this project?
Yes or No:
If yes, describe the level and means of public consultation (town-hall meetings, focus groups, advertising notices and level of response, one-on-one or small group meetings with concerned citizens, groups or neighbours to the project, etc.).
10. Describe the level of public support and/or concerns expressed regarding the construction, start-up, or operation of this project.
[Describe the nature (verbal, letters, media, etc.) of any sensitivity and any action(s) taken to assess/address the concerns.]
11. If the project involves restoring or refurbishing an existing building or structure, or is a new construction, is there any chance that lead-based paints will be scraped, sanded, sandblasted, or newly applied or will any kind of fuel tank be removed or installed?
Yes (specify) or No:
12. Are there any plans for additional phases to this project?
Yes (specify) or No:
13. Are there other details about the project that could have an impact on the environment? (on the physical, social, cultural, or economic environment or anything of an archaeological, architectural, historical, or paleontological significance)
Yes (specify) or No: