Republic of the Philippines

CITY ENVIRONMENT AND NATURAL RESOURCES OFFICE

CARBDP Bldg., Motorpool Compd., Doongan, Butuan City

MOUNTAIN SOIL QUARRY/SAND AND GRAVEL (SAG) MONITORING CHECKLIST

PARTICULARS NAME DESIGNATION SIGNATURE
Monitoring Team

Permit Holder/Representative:

Date of Monitoring:
Coverage of Monitoring
BASIC INFORMATION
Permit No.
Date Approved
Contractor/Permit Holder
Contract/Permit Area (hectares)
Location of the Contract/Permit Area
Commodity/Product
Allowable Volume
Mining Method
Type of Processing, if any

MONITORING CHECKLIST INSTRUCTIONS:

For items requiring level of compliance, please tick the appropriate box, according to the following:
Y – YES - There is sufficient and appropriate evidence to prove that the requirement has been complied.
N – NO - A clear proof that the requirement has not been complied.
P – PARTIAL - There is sufficient evidence to prove that the compliance is incomplete or ineffective.
ND – NOT DETERMINED - The needed information was not gathered due to certain factors, e.g.
NA – NOT APPLICABLE - The criteria of the monitoring do not apply.

For items not requiring level of compliance, fill-up the information required as derived from the actual monitoring.

MANDATORY DEVELOPMENT/OPERATING COMPLIANCE REQUIREMENTS

 COMPLIANT
REQUIREMENTS REMARK/S
YES NO
a. Five-Year Development/Utilization Work Program

b. 3D Quarry Plan
c. Environmental Protection and Enhancement
Program
d. Community Development Program

e. Safety and Health Program

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 PROJECT (DEVELOPMENT/OPERATING) PERFORMANCE CRITERIA

I. Implementation of the Fiver-Year Development/Utilization Work Program

Period covered: ___________________________________________

PARAMETERS TARGET ACCOMPLISHMENT REMARK/S
Production Volume/Tonnage
○ MT/Year ○ Cubic Meter/Year
Budget/Expenditures
Activities

a.

b.

c.

d.

e.
Mine Design Parameters
a. Bench Height

b. Bench Width

c. Bench Slope

d.

e.

f.

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II. Status of Compliance to the Provisions of Permit
COMPLIANCE
CONDITIONS/PROVISION REMARKS
YES NO
a. Execute a bond in the form and amount prescribed by the regulations, and with a surety/ies
satisfactory to the City Mayor to guarantee the performance of the Permit Holder's obligations and
faithful compliance with the provision of RA 7942 and the revised Implementing Rules and
Regulations (IRR) promulgated thereunder.
b. Established concrete ground monuments or any other prominent marks showing area
boundaries and extraction limits
c. Proof of payment of excise tax pursuant to Sec. 151 of the National Revenue Code

III. Submission of Reports

PERIOD REPORTING DATE SUBMISSION REMARK/S

REPORTS FOR SUBMISSION
COVERED PERIOD SUBMITTED ON TIME
LATE NONE
A. Sworn Monthly Report on Jan
Production and Sales of Quarry
Resources and Commercial Feb
Sand and Gravel and Mar
Employment (Reportorial
Apr
requirement based on Section 30,
Article IV of SP Ordinance No. May
3617-2010) Jun
 For Quarry Resource use MGB Form
No. 29-11 Jul
 For Commercial SAG use MGB Form Aug
No. 29-13
 For Industrial SAG use MGB Form 29- Sep
12 Oct
 Due date: Within 10 days after the Nov
end of each month
Dec
B. Sworn Statement of Previous
year Operating Costs (No
prescribed form)
 Due date: Within 60 days after the
end of each calendar year

(Note: In case of late or non-submission of reportorial requirements mentioned, the penalty stipulated in Item 9.3 Section 27 Article IV of SP Ordinance No.
3617-2010 shall be imposed)

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IV. Fiscal Obligations

LEVEL OF OFFICIAL RECEIPT DATE OF

AMOUNT PAID REMARK/S
FEES AND TAXES COMPLIANCE NO. PAYMENT
YES NO NA
a. Occupation Fee
b. Local Tax
c. Excise Tax
d. Income Tax
e. Other/s

V. Other Terms and Conditions and Provisions of Rules and Regulations

a. Facilities

CONSTRUCTED BUT
CONSTRUCTED AND IN NOT YET
FACILITIES DILAPIDATED/NEEDS REMARK/S
GOOD CONDITION CONSTRUCTED
REPAIR/RENOVATION

Motor pool/Workshop area

Administrative Office

Other/s (specify)

b. Human Resources

COMPLIANT WITH THE

TOTAL NUMBER FILIPINO FOREIGNER REQUIRED PERCENTAGE
FOR "FILIPINIZATION" REMARK/S

MALE FEMALE MALE FEMALE MALE FEMALE YES NO

HUMAN RESOURCES
Total number of personnel/laborers (Male/Female)
Total number of locals hired (Male/Female)
Total number of migrant workers (includes workers from Provinces, other than the host

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 province)
Total number of alien workers (specify nationality and designation)
Salary of Lowest Rank and File

c. Technical/Key Persons

COMPLIAN
HIRED/EMPLOYE T REMARK/S
TECHNICAL/KEY PERSONS
D (Provide Details of Hiring/Employment)
YES NO
Licensed Mining Engineer, Geologist or Metallurgical Engineer on-site to
supervise the activities under the approved 5Yr DUWP
Environmental Officer on-site to supervise the activities under the approved
EPEP
Safety Engineer/Safety Inspector on-site to supervise/manage the
implementation of the Safety and Health Program
Other findings

d. Equipment

STATUS
LIST OF EXISTING EQUIPMENT REMARK/S
O B PM
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
(Note: O – Operational; B – Breakdown; PM – Under Preventive Maintenance)
e. Mine Plan/Layout Showing the Location and Extent of Development/Extraction Activities

COMPLIANT REMARK/S
REQUIREMENTS (Provide Date of Last Revision/Updating)
YES NO

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 Mine plan/layout showing the location and extent of
development/extraction activities

f. Survey Plan of the Project Area

COMPLIANT REMARK/S
REQUIREMENTS
YES NO

Survey plan of the project area

Other Finding(S)/Observation(S)

___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________

Annexes
a. Photographs
b. Copy of pertinent documents

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 ENVIRONMENTAL MANAGEMENT (DEVELOPMENT/OPERATING) MONITORING CHECKLIST

MANDATORY ENVIRONMENTAL MANAGEMENT COMPLIANCE REQUIREMENTS

COMPLIANT
PARAMETERS LEGAL BASIS REMARK/S RECOMMENDATIONS
YES NO
1. Environmental Section 74 and
Protection and 169 of DAO 2010-
Enhancement Program 21
(EPEP)

ENVIRONMENTAL MANAGEMENT (DEVELOPMENT/OPERATING) PERFORMANCE CRITERIA

A. Physical Accomplishments

ACTIVITIES UNIT OF MEASURE TARGETS ACCOMPLISHMENTS REMARKS

1. Land Resource
a. Progressive Rehabilitation
b. Access Roads
c. Stockpiles
d. Waste Dumps
e. Settling/Siltation pond
f. Tree Planting/Vegetation enhancement
g.
2. Water Resource and Quality
a. Maintenance of settling/siltation pond

b. Solid Waste Management

c. Hazardous Waste Management (fuels and
chemicals, if any)

d.
e.
3. Air Quality

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 a. Dust suppression/water spraying

b.
c.

I. Reportorial Requirements

COMPLIANCE COMPLIANT DATE OF

PARAMETERS LEGAL BASIS REMARKS/RECOMMENDATIONS
INDICATOR YES NO SUBMISSION

1st Q
Date
submitted to &
1. Quarterly 2nd Q
Section 5.b of received by
Compliance
DAO No. CMRB within
Monitoring
2015-02 15 days 3rd Q
Report
Coverage
Period
4th Q

OTHER FINDINGS/OBSERVATIONS AND RECOMMENDATIONS:

FINDINGS RECOMMENDATIONS PENALTIES

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 COMMUNITY DEVELOPMENT MONITORING CHECKLIST

MANDATORY COMMUNITY DEVELOPMENT COMPLIANCE REQUIREMENTS

COMPLIANT
PARAMETERS LEGAL BASIS REMARK/S RECOMMENDATIONS
YES NO

1. 5-Year Community Section 134 and

Development Program 136-A of DAO
(CDP) 2010-21

COMMUNITY DEVELOPMENT PERFORMANCE CRITERIA

I. Implementation of Community Development Program

A. Physical and Financial Accomplishments

PHYSICAL FINANCIAL AVERAGE %

PROJECT/PROGRAM/ACITVITY (PPA)
TARGET ACCOMP % ALLOTMENT EXPENDITURES BALANCE %

a.

b.

c.

d.

e.

GRAND TOTAL

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OTHER FINDINGS/OBSERVATIONS AND RECOMMENDATIONS:

FINDINGS RECOMMENDATIONS PENALTIES

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 SAFETY AND HEALTH MONITORING CHECKLIST

MANDATORY SAFETY AND HEATH COMPLIANCE REQUIREMENTS

COMPLIANT
PARAMETERS LEGAL BASIS REMARK/S RECOMMENDATIONS
YES NO

1. Safety and Health Section 144 of

Program DAO 2010-21

2. Strict
Implementation of
Mine Labor Age Section 163 of
Limit (18 y/o for DAO 2010-21
Surface and
Underground)

I. Implementation of Safety and Health Program

COMPLIANT
PARAMETERS LEGAL BASIS REMARK/S RECOMMENDATIONS
YES NO
Section 2 of Rule
1. No. of Safety
8-11 of DAO No.
Engineer/Inspector
2000-98
2. Proper
Section 163 of
Housekeeping in
DAO 2010-21
the Workplace
Section 63, Rule
3. Provision of PPE 849 of DAO No.
2000-98
Section 63, Rule
4. Strict
850-856 & 858-
Implementation of
859 of DAO No.
wearing PPE
2000-98

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II. Safety and Health Program Budget Utilization

FUND UTILIZATION
ELEMENTS OF SAFETY AND HEALTH
COMMENTS/RECOMMENDATIONS
PROGRAM ANNUAL BUDGET AMOUNT UTILIZED PERCENTAGE (%)

A. Proper Housekeeping
B. Provision of PPE

C. Others

TOTAL

*Safety and Health Activities are not limited to the above-mentioned elements.

III. Reportorial Requirements

COMPLIANCE COMPLIANT
PARAMETERS LEGAL BASIS REMARKS/RECOMMENDATIONS
INDICATOR YES NO

Monthly Accident
1. On-Time Submission of
Section 155 (b.1) of and Sicknesses
Monthly Accident and
DAO 2010-21 Report on MGB
Sicknesses Report
Form 15-5

OTHER FINDINGS/OBSERVATIONS AND RECOMMENDATIONS:

FINDINGS RECOMMENDATIONS PENALTIES

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