Environmental Assessment Form (EAF) This form is to assist the reviewers in determining whether a proposed action could cause significant natural and socioeconomic environmental effects and thus require an environmental effects report. Department _______________________________ Division _________________________ Other ____________________________________________________________________ Project Title _______________________________________________________________ Predicted Dates: Commencement _______________________________________________ Completion _____________________________ Projected Cost _______________________ Background Information. Give a brief description of the proposed action/project(s). Describe the geographical area(s) which will be affected by the action/project(s); specifically locate the project by using the Maryland coordinate grid system; include distinguishing natural and man-made features and a brief description of the present use of the area(s). Include a suitable location map (sketch map or copy of U.S. Geological Survey Map, etc.). Assessment of Significant Environmental Effects. The following questions should be answered by placing a check in the appropriate column(s). If desirable, the “comments attached” column can be checked by itself or in combination with an answer of “yes” or “no” to provide additional information or to overcome an affirmative presumption. In answering the questions, the significant beneficial and adverse, short-term and long-term effects of the proposed action, on site and off site during construction and operation should be considered. All questions should be answered as if the agency is subject to the same requirements as a private person requesting a license or permit from the State or federal government. Summary of Environmental Effects Report. Attached to the front of every environmental effects report should be a one or two page summary in substantially the following form: Kind of action: _________________________ request for legislative appropriation, i.e., requests for capital budget items, requests for encumbrances upon special funds or trusts, and bond issues. Official responsible for issuance of this statement (name, address, telephone). Official responsible as a contact for questions in regard to the environmental effects report. Name, location, and brief description of the action. Summary of environmental effects for the following: List of alternatives considered. List all federal, State, and local agencies and other sources from which written comments have been requested. Date statement was sent to Clearinghouse.