ENVIRONMENTALSCREENINGFORM.docVIP

ENVIRONMENTAL and HISTORIC PRESERVATION SCREENING MEMO (EHPSM) This memo should be attached to all project information sent to the Grant Programs Directorate (GPD) for an environmental and historic preservation (EHP) regulatory compliance review. Please complete sections A – D of this memo, as applicable. When questions are not applicable to the project, please leave the field blank. This memo is intended to be completed electronically. Please contact GPD-EHP for a version of this memo that is suitable for printing and completing by hand. To check (X) a box, please left double-click using your mouse and a Check Box Field Form Box will appear. On the Check Box Field Form Box, select the default value as Checked and press OK. To write in a text field (), please select the text field with your mouse and begin typing. A. PROJECT INFORMATION Grant Program Name: Grant Award Number: Project Type (Check all that apply): Physical security enhancements (i.e., installation of fencing, cameras, TWIC readers, bollards, motion detection systems, x-ray machines, lighting, etc.) New installation/construction/renovation (i.e., emergency operations centers, docks, piers, security guard buildings, etc.) Renovations/upgrades/modifications to structures 50 years old or older Communication towers, related equipment, and equipment shelters Other ground disturbing activities (i.e., trenching, excavation, etc.) Training and exercises (field-based only require further information) Purchase of equipment (specify) Other (specify) Grantee Name: State: County: Agency: Subgrantee: Project Title: Fiscal Year: B. PROJECT DESCRIPTION/LOCATION (The following information will be required in order to complete a review for each project type. If multiple “project types” describe the same project, [i.e., physical security enhancements AND renovations of structures 50 years old or older AND o