Environmental Impact Decision Making
Use this form to assess, document, and guide decisions regarding the environmental impact of proposed projects or actions.
Project or Action Title
*
Project/Action Description
*
Location of Project/Action
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Decision Maker(s) Name
*
First Name
Last Name
Type of Project/Action
*
Please Select
Construction
Industrial
Agricultural
Infrastructure
Other
Environmental Impact Assessment Table
*
Rows
No Impact
Minor Impact
Moderate Impact
Significant Impact
Air Quality
1
2
3
4
Water Quality
5
6
7
8
Soil and Land
9
10
11
12
Biodiversity
13
14
15
16
Noise
17
18
19
20
Waste Generation
21
22
23
24
Describe any proposed mitigation measures to reduce negative environmental impacts.
Were alternative actions or locations considered?
*
Yes
No
If yes, please describe the alternatives and why they were not selected.
Stakeholder or community input received
Public consultation held
Feedback from environmental agencies
Input from local community
No input received
Final Decision/Recommendation
*
Approve as proposed
Approve with mitigation
Request further assessment
Reject
Rationale for the decision/recommendation
*
Upload supporting documents (e.g., reports, maps, studies)
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