ANNEX 3 - PHASE 2 ENVIRONMENTAL for FY22 RFA.pdf

ANNEX 3 – ENVIRONMENTAL CAPABILITY STATEMENT1 TEMPLATE

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

USO Name:

OSI Name:

Commodities Only Construction Only Construction with 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 below.

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? Please describe below. 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) _______ Please describe below.

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.

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 below.

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 below.

1 This 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.

2 Refer to the USAID Global Construction PERSUAP (2020):

https://ecd.usaid.gov/document.php?doc_id=52687 OR http://ow.ly/8WCJ50CgD0g