ANNEX 3 - PHASE 2 ENVIRONMENTAL for FY21 RFA.pdf

ANNEX 3 – ENVIRONMENTAL CAPABILITY STATEMENT TEMPLATE 1

Applicants must complete all questions below and submit to ASHA with the application.

USO Name:

OSI Name:

Commodities Only Construction with Commodities without Commodities

NOTE: Applicants are advised to review guidance for each question as in the ASHA Initial Environmental Examination (IEE) of ASHA environmental policies and procedures globally.

1. Institutional Arrangements: Do you have an A&E firm or internal staffing to complete the IEE and CRM analysis and implementation? (Yes/No): _______. Please describe:

2. Site Selection: Will the project be located in or near sensitive ecosystems and-or hazard prone areas? (Yes/No).______ If Yes, what are the mitigation or corrective actions? Has any cognizant organization (Internal Staff, A&E firm, Host National Ministries) verified these actions are sufficient? (Yes/No).______ If Yes, who?

3. Toxics: Will toxic materials be involved (e.g., asbestos)? (Yes/No/Not Applicable):______ If yes, what are they, why are they being proposed and what are the mitigation measures being taken?

4. Pesticides: Will the project need to address pest control and (if relevant) procure and or use pesticides? (Yes/No): _______ Are any pesticides that are needed already described in the USAID ASHA Construction Pesticide Evaluation and Safe Use Action Plan or PERSUAP2?(Yes/No): _______

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5. Water Supply: Will you have enough future water capacity to meet the needs of your facility with the commodities and/or additional building features requested? (Yes/No):

_______. Please describe below. How will you protect this water from contamination during construction or waste disposal activities?

6. Solid Waste: Describe your current solid waste disposal practices (whole facility). Will you need to upgrade your disposal and collection system to accommodate this grant request?

(Yes/No).______ If yes, please describe the changes.(note: Include any temporary spike or surge such as disposal of packing material or construction debris, as well as long-term needs such as from future population).

7. Sanitary Waste: Describe your current sanitary waste disposal practices (whole facility) .Will you need to upgrade your disposal and collection system to accommodate this grant request? (Yes/No).______ If yes, please describe the changes. (note: Include any temporary spike or use such as from construction workers as well as long-term needs such as from future population).

8. Medical Waste: Describe your current medical waste disposal practices (whole facility).

Will you need to upgrade your disposal and collection system to accommodate this grant request? (Yes/No). ______If yes, please describe the changes. (note: Include any temporary spike or use as well as long-term needs). If you do not have medical waste at this facility, write Not Applicable and move to Question 9.

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9. Energy: Will the project employ energy efficiency measures and/or non-fossil fuel energy sources (e.g., hydropower, wind and solar panels)? (Yes/No): _______ Please describe.

10. Climate Risks and Opportunities: How does the commodity or facility resist the effects of climate change? Have these measures been considered or incorporated into the features either by the commodity manufacturer, A&E design, site selection or by other means?(Yes/No): _______Please describe:

1This statement of capability is developed by the applicant at the pre-award stage only. Following award, successful awardees are required to submit additional environmental and climate analyses as described in the ASHA Global IEE.

2Refer to the USAID Global Construction PERSUAP (2020): https://ecd.usaid.gov/ document.php?doc_id=52687 OR http://ow.ly/8WCJ50CgD0g