Young Researchers and Professionals Program, 3C Grant Research in Industry and Academia –– Environmental Screening Form 2012
Environmetal Screening Form
Annex A -Environmental Screening Form is an integral part of the “Environmental Management Framework”, please read this document for guidelines.
PART 1: APPLICATION (filled by applicants)Sub-beneficiary
PROJECT TITLE
Scope of project and activity – project description
Institution supporting/supervising the project
What are the potential environmental impacts of the project?
TESTING *
Will the project finance testing phase?
Please describe testing phase
Please specify outdoor or indoor? g
PERMITS
What permits are required for project preparation and / or testing?
PART 2: SCREENING (filled by applicants, checked by PB)
Screening category according to national Regulation on EIA** / Annex 1 Yes No
Annex 2 Yes No
Annex 3 Yes No
No annex Yes No
If no annex (if proposed project is not listed in annexes of the Regulation above), please answer: / Does it include construction or rehabilitation of buildings or infrastructure? / Yes No
Does it include assembling? / Yes No
Does this sub project include software development or similar IT work? / Yes No
Does the project include use of radioactive material? / Yes No
- If so what and for what purposes?
- What quantities?
- What accreditation laboratory has for use of such materials?
Does the project include use of cancerogenic, theratogenic or mutagenic substances? / Yes No
- If so what substances and for what purposes?
- What quantities?
- What accreditation laboratory has for use of such materials?
Does the project predict testing on animals? / Yes No
- If so what substances and for what purposes?
- What animals?
- What accreditation laboratory has for testing?
Does the project include Activities Generally Ineligible for IBRD financing? / Yes No
Signature
Confirming truthfulness of the provided in the table
*Testing as testing of the project results
** „Uredba o procjeni utjecaja zahvata na okoliš“ NN 64/08, 67/09.