NPS Director's Order 12: Conservation Planning, Environmental Impact Analysis and Decision Making
Table of Contents
Disclaimer Information
Biscayne National Park, FLAppendix 1 — Environmental Screening Form

(revised November 2003)

View pdf version of this form. (Get the Adobe Acrobat PDF Reader 5.0 to read the document.)

This form must be attached to all documents sent to the regional director's office for signature. Sections A and B should be filled out by the project initiator (may be coupled with other park project initiation forms). Sections C, D, E, and G are to be completed by the interdisciplinary team members. While you may modify this form to fit your needs, you must ensure that the form includes information detailed below and must have your modifications reviewed and approved by the regional environmental coordinator.

A. PROJECT INFORMATION

Park Name ___________________________________________________________________________
Project Number _______________________________________________________________________

Project Type (Check):

Cyclic Cultural Cyclic Repair/Rehab ONPS
NRPP CRPP FLHP  
Line Item Fee Demo Concession Reimbursable  
Other (specify)_____________________________________________________________________________________

Project Location ______________________________________________________________________
Project Originator/Coordinator ___________________________________________________________
Project Title __________________________________________________________________________
Contract # ___________________________________________________________________________
Contractor Name ______________________________________________________________________
Administrative Record Location ___________________________________________________________
Administrative Record Contact ___________________________________________________________

B. PROJECT DESCRIPTION/LOCATION [To begin the statutory compliance file, attach to this form, maps, site visit notes, agency consultation, data, reports, categorical exclusion form (if relevant), or other relevant materials.]
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Preliminary drawings attached? Yes No
Background info attached? Yes No
Date form initiated ______________________________________________________________________
Anticipated compliance completion date _____________________________________________________
Projected advertisement/Day labor start _____________________________________________________
Construction start _______________________________________________________________________

C. RESOURCE EFFECTS TO CONSIDER (Tailor the following to meet individual park/unit project needs.)

Please see section F (Instructions for Determining Appropriate NEPA Pathway) prior to completing this
section. Also, use the process described in DO-12, 2.9 and 2.10; 3.5; 4.5(G) to (G)(5) and5.4(F) to help
determine the context, duration and intensity of effects on resources.

Are any impacts possible on the following physical, natural or cultural resources? Yes No Data Needed to Determine
1. Geological resources-soils, bedrock, streambeds, etc.      
2. From geohazards
     
3. Air quality
     
4. Soundscapes      
5. Water quality or quantity      
6. Streamflow characteristics
     
7. Marine or estuarine resources
     
8. Floodplains or wetlands
     
9. Land use, including occupancy, income, values, ownership, type of use
     
10. Rare or unusual vegetation-old growth timber, riparian, alpine
     
11. Species of special concern (plant or animal; state or federal listed or proposed for listing) or their habitat
     
12. Unique ecosystems, biosphere reserves, World Heritage sites
     
13. Unique or important wildlife or wildlife habitat
     
14. Unique or important fish or fish habitat
     
15. Introduce or promote nonnative species (plant or animal)
     
16. Recreation resources, including supply, demand, visitation, activities, etc.
     
17. Visitor experience, aesthetic resources
     
18. Cultural resources, including cultural landscapes, ethnographic resources
     
19. Socioeconomics, including employment, occupation, income changes, tax base, infrastructure
     
20. Minority and low-income populations, ethnography, size, migration patterns, etc.
     
21. Energy resources
     
22. Other agency or tribal land use plans or policies
     
23. Resource, including energy, conservation potential
     
24. Urban quality, gateway communities, etc.
     
25. Long-term management of resources or land/resource productivity
     
26. Other important environmental resources (e.g., geothermal, paleontological resources)
     
Mandatory Criteria: If implemented, would the proposal:
Yes
No
Data Needed to Determine
A. Have material adverse effects on public health or safety?
     
B. Have adverse effects on such unique characteristics as historic or cultural resources; park, recreation, or refuge lands; wilderness areas; wild or scenic rivers; national natural landmarks; sole or principal drinking water aquifers; prime farmlands; wetlands; floodplains; or ecologically significant or critical areas, including those listed on the National Register of Natural Landmarks?
     
C. Have highly controversial environmental effects?      
D. Have highly uncertain and potentially significant environmental effects or involve unique or unknown environmental risks?
     
E. Establish a precedent for future action or represent a decision in principle about future actions with potentially significant environmental effects?
     
F. Be directly related to other actions with individually insignificant, but cumulatively significant, environmental effects?
     
G. Have adverse effects on properties listed or eligible for listing on the National Register of Historic Places?
     
H. Have adverse effects on species listed or proposed to be listed on the List of Endangered or Threatened Species, or have adverse effects on designated Critical Habitat for these species?
     
I. Require compliance with Executive Order 11988 (Floodplain Management), Executive Order 11990 (Protection of Wetlands), or the Fish and Wildlife Coordination Act?
     
J. Threaten to violate a federal, state, local, or tribal law or requirement imposed for the protection of the environment?
     
K. Involve unresolved conflicts concerning alternative uses of available resources (NEPA sec. 102(2)(E)?      
L. Have a disproportionate, significant adverse effect on low income or minority populations (EO 12898)?      
M. Restrict access to and ceremonial use of Indian sacred sites by Indian religious practitioners or adversely affect the physical integrity of such sacred sites (EO 130007)?      
N. Contribute to the introduction, continued existence, or spread of federally listed noxious weeds (Federal Noxious Week Control Act)?      
O. Contribute to the introduction, continued existence, or spread of non-native invasive species or actions that may promote the introduction, growth or expansion of the range of nonnative invasive species (EO 13112)?      
P. Require a permit from a federal, state, or local agency to proceed, unless the agency from which the permit is required agrees that a CE is appropriate?      
Q. Have the potential for significant impact as indicated by a federal, state, or local agency or Indian tribe?
     
R. Have the potential to be controversial because of disagreement over possible environmental effects?      
S. Have the potential to violate the NPS Organic Act by impairing park resources or values?      

Please answer the following questions:

1. Are the personnel preparing this form familiar with the site, and/or has a site visit been
conducted? (Attach additional pages noting when site visit took place, staff attending, etc.)

 

 

 

2. Has consultation with all affected agencies or tribes been completed? (Attach additional pages
detailing the consultation, including the name, date, and summary of comments from other agency
or tribal contacts.)

 

 

 

E. OTHER INFORMATION (Please answer the following questions/provide requested information.)

Are personnel preparing this form familiar with the site? Yes No

Did personnel conduct a site visit? Yes No (If yes, attach meeting notes or additional pages noting when site visit took place, who attended, etc.)

Is the project in an approved plan such as a General Management Plan or an Implementation Plan with an accompanying environmental document? Yes No
If so, plan name ____________________________________________________________________

Is the project still consistent with the approved plan? Yes No (If no, prepare plan/EA or EIS.)

Is the environmental document accurate and up-to-date? Yes No (If no, prepare plan/EA or EIS.) FONSI ROD (Check) Date approved _________________

Are there any interested or affected agencies or parties? Yes No

Did you make a diligent effort to contact them? Yes No

Has consultation with all affected agencies or tribes been completed? Yes No
(If so, attach additional pages detailing the consultation, including the name, the dates, and a summary of comments from other agencies or tribal contacts.)

Are there any connected, cumulative, or similar actions as part of the proposed action? Yes No
(If so, attach additional pages detailing the other actions.)

F. INSTRUCTIONS FOR DETERMINING APPROPRIATE NEPA PATHWAY

First, always check DO-12, section 3.2, “Process to Follow” in determining whether the action is
categorically excluded from additional NEPA analyses. Other sections within DO-12, including
sections 2.9 and 2.10; 3.5; 4.5(G)(4) and (G)(5), and 5.4(F), should also be consulted in
determining the appropriate NEPA pathway. Complete the following tasks: conduct a site visit or
ensure that staff is familiar with the site's specifics; consult with affected agencies, and/or tribes;
and interested public and complete this environmental screening form.

If your action is described in DO-12 section 3.3, “CE’s for Which No Formal Documentation is
Necessary,” follow the instructions indicated in that section.

If your action is not described in DO-12, section 3.3, and IS described is section 3.4, AND you
checked yes or identified “data needed to determine” impacts in any block in section D (Mandatory
Criteria), this is an indication that there is potential for significant impacts to the human
environment, therefore, you must prepare an EA or EIS or supply missing information to determine
context, duration and intensity of impacts.

If your action is described in section 3.4 and NO is checked for all boxes in section D (Mandatory
Criteria), BUT you have initially checked “yes” in section C (Resource Effects to Consider) during
internal scoping, this means that the team should do additional analyses to determine the context,
duration and intensity of effects. If the magnitude of effects is then determined to be at the
negligible or minor level, then usually there is no potential for significant impacts, then an EA or EIS
is not required. If, however, during internal scoping and further investigation, resource effects still
remain unknown, or are at the minor to moderate level of intensity, and the potential for significant
impacts may be likely, an EA or EIS is required.

In all cases, data collected to determine the appropriate NEPA pathway must be included in the
administrative record.

G. INTERDISCIPLINARY TEAM SIGNATORY (All interdisciplinary team members must sign.)

By signing this form, you affirm the following: you have either completed a site visit or are familiar with the specifics of the site; you have consulted with affected agencies and tribes; and you, to the best of your knowledge, have answered the questions posed in the checklist correctly.

Interdisciplinary Team Leader Name

Field of Expertise
Date Signed
Technical Specialists' Names
Field of Expertise
Date Signed
     
     
     
     
     
     
     
     
     

H. SUPERVISORY SIGNATORY

Based on the environmental impact information contained in the statutory compliance file and in this environmental screening form, environmental documentation for the subject project is complete.

Recommended:

Compliance Specialist

Telephone Number Date
     

Approved:

Superintendent

Telephone Number Date
     

 

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