Initial Environmental Examination (IEE) Form for Industrial Projects -2017
Note 1: In accordance with section 47 of the Regulation for Environmental
Clearance of Projects 2016, consent must be obtained from individual or
juristic person if activity has direct impact on a property.
Note 2: The completed IEE form shall be submitted to the relevant Competent
Authority.
Note 3: The completed IEE form shall be the basis to determine the requirement
of Environmental Impact Assessment (EIA). If EIA is required, applicant
will be notified to submit Terms of Reference for the project.
Note 4: The application shall be subjected to Fee Schedules to cover the cost of
administering the Environmental Assessment Act, 2000.
1. General Information:
a) Name of the project:………………………………………
b) Project Type (Tick as appropriate): ☐ New ☐ Expansion/modification
c) Applicant Details:
I. Name of the applicant:………………………………………
II. Address:………………………………………
III. Post Box No.:………………………………………
IV. Contact No.:………………………………………
V. Fax No.:………………………………………
VI. Email:………………………………………
VII. Name and contact details of Environmental Focal Person:…………………
2. Project Location:
I. Dzongkhag/Thromde: ………………………………………
II. Gewog:………………………………………
III. Village:………………………………………
IV. Name of the project site:……………………………………..
3. Project Cost (Nu.):………………………………………
4. Project area, tick as appropriate:
a) ☐Industrial Area……………….acres
b) ☐Industrial Estate……………….acres
c) ☐State Reserve Forest……………….acres
d) ☐Private……………….acres
e) ☐Others……………….acres
f) Total area required……………….acres
Note: If the activity is proposed in industrial area /estate, skip sections 5 and 6
5. Terrain characteristic at the project site
a) Elevation (meter):……….
b) Aspect (direction):……….
c) Slope (degree/%):……….
6. Presence of any of the following within and 50 meters buffer of the project area. If yes
tick and mention name, wherever applicable:
a) ☐River/spring/stream……………………………………………….
b) ☐Protected Area…………………………………………
c) ☐Catchment area………………………………………..
d) ☐Wetland……………………………………………….
e) ☐Community forest……………………………………………….
f) ☐Private forest……………………………………………….
g) ☐Tsamdro………………………………………………..
h) ☐Sokshing……………………………………………..
i) ☐Agriculture land…………………………………………..
j) ☐Heritage site………………………………………………..
k) ☐Hospital………………………………………………
l) ☐School/institution………………………………………………
m) ☐Roads……………………………………………….
n) ☐Industries……………………………………………….
o) ☐Settlements……………………………………………….
p) ☐Presence of religious site……………………………………………….
q) ☐Archaeological site……………………………………………….
r) ☐Others
7. Project Details (attached in a separate sheet):
a) Project objective:………………………………………………………
b) Final products:…………………………………………………………
c) Installed capacity:…………………………………………………………
d) For medium and large-scale industries provide brief information on process
mechanism from use of raw material to the final product without getting into details
of thermo-chemistry
e) Total built up area (acre):……………………………………………..
f) List of major materials and quantity to be used:………………………
g) Methods of storing materials and final prodcuts:……………………………………
h) Source of water and total requirement -m3/day:………………………
i) Source of energy, tick as appropriate:
☐Electricity, if yes, Tapping point:………………………………..
☐Coal
☐Fossil fuel
☐Solar
☐Wood
☐Others
8. Ancillary activities, tick as appropriate:
a) ☐Power line
b) ☐Approach road
c) ☐Others
Note: For ancillary activities, fill up relevant IEE forms and submit along with these IEE
forms.
9. List type of wastes under each category and its quantity per annum, tick as appropriate:
a) ☐Solid:………………………………
b) ☐Liquid/effluent:……………………
c) ☐Air/Gaseous:………………………
10. Provide maximum noise level at the project boundary during operation, if applicable:
11. Environmental Management Plan (attached in a separate sheet):
Briefly describe mitigation measures to address impacts including sections 9 and 10
12. List of documents to be attached with this IEE form:
1 Sectoral Clearance (DOPFS/DoR/BPC etc.), if applicable
2 Dzongkhag/Thromde Administrative approval
3 Public consultation records verified by the concerned local authority
4 Layout plan and KMZ file depicting entire layout plan
Note: If the activity is proposed in the industrial area/estate, list of document from 1 to 3 are
not required.
Name and signature of the project proponent:
Address:
Date:
