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.

Interdisciplinary Team Leader Name

Compliance Specialist

Superintendent