1.0. Date and Time of Site Visit
Record date and time of site visit.
2.0. Land Quality

Will the proposed action involve digging, drilling, scraping, trenching, or another form of soil disturbance?

Describe the nature and level of disturbance.

Will the action or project cause any damage to native vegetation?

Are there any natural washes or storm water channels within 75 feet of the location of the proposed action?

Will the proposed action disturb one acre or more?

Will erosion or sediments be a concern during storm events?

Will any noise, traffic, or visual aesthetic of the desert region be generated or altered which may affect off-base persons, prosperity, or wildlife?

Has the proposed project area been previously disturbed? If yes, briefly describe level of disturbance.

Is there any evidence of prior soil contamination?

3.0. Cultural and Natural Resources

Will the proposed action take place on or adjacent to an environmentally sensitive area?

Briefly describe area or location.

Will any known cultural or historical resource be affected at the site of the proposed action?

Briefly describe affected resource.

Will any known threatened or endangered species (plant or animal) be affected by the proposed action?

4.0. Installation Restoration

Is there an installation restoration site at or near the location of the proposed project?

Provide IR site name.

5.0. Signature Block
Signature of Person Conducting Site Visit
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.