Cultural Heritage Land Use Assessment Form
Evaluate how proposed land use or site activities may impact cultural heritage resources. Please complete all sections based on your assessment.
Site or Project Name
*
Site Location / Context
*
Description of Proposed Land Use or Project Activities
*
Proximity to Known Heritage Assets
*
Within heritage site boundary
Adjacent to heritage site
Nearby (within 500m)
No known heritage assets nearby
Existing Heritage Value of the Site
*
None
1
2
3
4
Exceptional
5
1 is None, 5 is Exceptional
Potential Impact on Heritage Resources
*
1
2
3
4
5
Mitigation Measures Needed?
*
Yes
No
To be determined
Stakeholder Consultation Status
*
Completed
In progress
Not started
Assessment of Key Aspects
*
Rows
No Impact
Minor Impact
Moderate Impact
Major Impact
Visual setting
1
2
3
4
Archaeological remains
5
6
7
8
Architectural features
9
10
11
12
Traditional land use
13
14
15
16
Overall Assessment Outcome / Recommendation
*
Please Select
Approve as proposed
Approve with mitigation
Further study required
Reject
Submit Assessment
Should be Empty: