Annex D - Environmental and Aboriginal Consultation Information Requirements

As part of the application process for funding, applicants are required to complete the following questionnaire, found in Annex D of the Business Case Guide, in order for Infrastructure Canada (INFC) to determine if the Canadian Environmental Assessment Act, 2012 (CEAA, 2012) and/or environmental assessment process in Northern Canada apply to the project. In addition, the information provided will also be used by INFC to determine if there is a requirement to consult with Aboriginal Groups.

All yellow highlighted text is instructional and is provided to explain in more detail the type of information requested by INFC.  This instructional text can be deleted once information is provided in the appropriate boxes. Please provide your response in the spaces provided in the boxes, and use as much space as necessary. 

Note that if you have any questions filling out the questionnaire; please submit your questions to the following email address: INFC.AboriginalConsultEnv-Consultautochtonesenv.INFC@canada.ca.

General information 		
Project Name:  

Project Proponent:  
	
Contact person for any question Infrastructure Canada  could have regarding the environmental assessment and aboriginal consultation:

Name: 
Address:
Phone:
Email:	

Note (scope change):  If you are completing this questionnaire due to a proposed project amendment for a project already submitted to Infrastructure Canada (INFC), please only include the amended project information.  

Project and existing environment description 	
Project Description:

	
Description of the existing environment:

	

Project Location Part

PL.1.1: Would any part of the project or activities be located on:	
Yes     No 	Federal land. If yes, provide details regarding the federal land administrator:	
Yes     No 	Provincial land. If yes, provide details:	
Yes     No 	Indian Reserve land. If yes, provide details:	
If you answered “yes” to any of the above.	Is the entire project footprint located on that land? 
If not, please indicate the portions that will take place on that land (provide a map).	Yes     No 	

PL.1.2: Would any part of the project or activities be located in: 	
Yes     No 	Internal waters of Canada, in any area of the sea not within a province

Internal waters refers to: the internal waters of Canada as determined under the Oceans Act, including the seabed and subsoil below and the airspace above those waters.	
Yes     No 	The territorial sea of Canada, in any area of the sea not within a province

Territorial sea refers to: 
The territorial sea of Canada as determined under the Oceans Act, including the seabed and its subsoil below and the airspace above that sea.	
Yes     No 	The exclusive economic zone of Canada

Exclusive economic zone refers to: 
The exclusive economic zone of Canada as determined under the Oceans Act, including the seabed and its subsoil.	
Yes     No 	The continental shelf of Canada

Continental shelf refers to: the continental shelf of Canada as determined under the Oceans Act.	
If you answered “yes” to any of the above:	Please provide the information regarding the land administrator.	

PL.2 In order to facilitate and accelerate INFC’s assessment of your application for funding, please provide an accurate project location in order for INFC to geographically locate your project.	
Option 1:  Project with a fixed address	
Address of the project
Civic Number:
Unit/Suite/Apt:
Street Name:
Municipality:
County:
Province:
Postal Code:	Location 1
	Location 2
	
Project Longitude:
Project Latitude:		
Option 2: Project with no fixed address or multiple components	
Please indicate, for each project component, any points of interest, intersections, major highways or streets, or other physical characteristics located in the vicinity of the project (e.g. near airport, adjacent to Lions Gate Bridge, 3 km east from Centennial Park, at intersection of Fifth and Queen, etc.)	
Component A:	
Component B:	
Component C:	

PL.3 Project Location Documents	
A project location map, as a minimum, has been included with this questionnaire.
If available, include also any other additional project map (e.g. site plan, etc.) that may be useful in locating the project.	Yes 	

Environmental Requirement Part

ER.1.1:  Does any part of your project involve the construction, operation, decommissioning or abandonment of the following infrastructure? 	
Yes   No 	Electrical transmission lines	
Yes   No 	Electrical generating facility	
Yes   No 	Structure for the diversion of water including dam, dyke or reservoir	
Yes   No 	Canal, lock or structure to control water level	
Yes   No 	Oil and gas pipeline	
Yes   No 	Marine terminal	
Yes   No 	Railway line and / or Railway yard	
Yes   No 	All season public highway	
Yes   No 	Aerodrome or airport runway	
Yes   No 	Hazardous waste facility	
Yes   No 	Waste management facility	
Yes   No 	Industrial facility	

ER.1.2: Are any part of the project or activities proposed within: 	
Yes   No 	A wildlife area

A wildlife area means: (according to the wildlife areas listed in Schedule 1 of the Wildlife Area Regulations). 

To use this list, find the section corresponding to the province in which the project is located and then determine if the project is located in one of the wildlife areas listed. If necessary, the cadastral lot numbers can be used.
	
Yes   No 	A migratory bird sanctuary

A migratory bird sanctuary means: (according to the migratory bird sanctuaries listed in the schedule of the Migratory Bird Sanctuary Regulations). 

To use this list, find the section corresponding to the province in which the project is located and then determine if the project is located in one of the bird sanctuaries listed. If necessary, the geographical coordinates expressed in latitude and longitude can be used.	

ER.1.3: Is the project a designated project according to the Regulations Designating Physical Activities*?  
*http://laws-lois.justice.gc.ca/eng/regulations/SOR-2012-147/index.html 
If a project appears on the list, it will likely be considered a designated project and has to be referred to the Canadian Environmental Assessment Agency.  Should this be the case, it is recommended you contact them as soon as possible to confirm their requirement and process.  	
Yes 	Please elaborate:	
No 		
Unknown 	It is possible that the project’s status in the Regulations Designating Physical Activities is unknown at the time of the application.	

ER.1.4: If you have answer yes to previous question ER1.3 (i.e. the project is a designated project), have you provided the Canadian Environmental Assessment Agency with a project description as per Section 8(1) of the Canadian Environmental Assessment Act, 2012?	
Yes     No 

To learn more about the information required by the Canadian Environmental Assessment Agency (Agency), please refer to the Prescribed Information for the Description of a Designated Project Regulations 	

ER.2:  Does the project (either in full or in part) require an environmental assessment under a northern regime or other regime?	
Yes 	Please elaborate:	
No  		

ER.3: Are public concerns expected as a result of this project?

The project may have potential to cause significant public concern. Here is a non-exhaustive list of examples: 

•Water and/or land use disputes and the possible cumulative effects of an unequal distribution of access rights to the land or water in question;
•Health and safety risks from potential accidents (e.g. potential spills in water bodies, etc.);
•Breaches of the cultural values of local communities;
•Etc.

If the public is concerned about the project, information on the nature of the concern and any other relevant information must be provided to INFC.
	
Yes 	Please elaborate:	
No  		

ER.4.1: Are environmental issues expected as a result of this project?	
Yes 	Please elaborate:	
No  		

ER.4.2:  Is any part of the project located in whole or in part on land potentially contaminated by previous activities:	
Yes 	Please elaborate:	
No  		

ER.4.3: Is an environmental site assessment available for this project regarding contaminated site(s): 	
Yes 	No  	Phase I	
Yes 	No  	Phase II	
Yes 	No  	Phase III	
If you answered “yes” to any of the above, please provide copies of all reports related to the project, if not already provided.  If the report(s) is/are at the development stage, please indicate the phase, and when a copy will be provided to INFC.

ER.4.4:  Does the project (either in full or in part) require a provincial environmental assessment?	
Yes 	If not already provided, please provide copies of all reports related to the project.  If the report(s) is/are at the development stage, please indicate when it/they will be completed and when a copy will be provided to INFC.	
No  		

Aboriginal Consultation Part

This section contains a number of questions aimed at developing a better overview of the types of activities and/or work that will be carried out to determine the potential impact it could have on the Aboriginal or treaty rights of Aboriginal peoples. To determine whether the Crown conduct could have an adverse impact on established or potential Aboriginal or treaty rights, information must be compiled on those rights, which could include the right to hunt, fish, trap, gather and trade, and may either be established by a court or in a treaty, or may be asserted by an Aboriginal group, for example, in litigation or for the purpose of negotiating a treaty.

This step must be taken into consideration very early on in the process otherwise project delays can be expected if consultation is not completed satisfactorily or in a timely manner.

AC.1:   Activities Related to the Project that could potentially impact Aboriginal rights.

Examples of traditional Aboriginal activities can vary, and include gathering wild mushrooms and medicinal herbs on a river bank, fishing in a salmon river, hunting moose in the forest, and may involve ceremonial sites and former burial grounds.

If one or more of the questions in this part are answered in the affirmative, please provide a description of the activity or activities in the last line of the table. 
	
Yes 	No  	Does the project involve works or activities on, under, over, through or across a water body such as a wetland, stream, river or lake?

Check all that apply. 

Fresh water:	 Stream    Lake	 Wetland	 River			 Pond	    Reservoir	 Active Floodplain
                         Fish Bearing Watercourse

Coastal and Marine:  Beach	       Cove	 Mud Flat			          Salt Marsh   Bay	 Exposed Coastline	                        Estuary	       Fish Bearing Watercourse

Other:   Please describe:

Yes 	No  	Can the work proposed have upstream or downstream impacts (e.g. change in water or temperature level upstream that could result in positive or negative impacts downstream, change in the turbidity, etc.)?	
Yes 	No  
	Are there activities proposed that may affect aboriginal traditional activities.  Check all activities that apply.

 Fishing (e.g., preventing access to a fishing area or work in a waterbody such as river, lake, stream, culverts ) 

 Hunting (e.g., preventing access to a hunting area or clearing of forest or other vegetation etc.)	

 Gathering (e.g., preventing access to a gathering area or clearing of forest or other vegetation etc.)

 Other (e.g. work close to or preventing access to sites of cultural/historical/archeological/ceremonial significance near the project etc.)		
Yes 	No  	Is the project (in full or in part) occurring on undisturbed or undeveloped land?

If yes, please provide information about how much land will be affected by the project in the appropriate space. Disturbed and/or developed land may include land that has undergone deforestation, land previously used for agricultural purposes, or land that has been built up (e.g. buildings were previously constructed upon, etc.).  	
Yes 	No  	Is any component of the proposed project located outside the existing infrastructure footprint (build up footprint)?	
Yes 	No  	Are there any relevant project activities that might affect other aspects of the environment (e.g. increases sound and/or noise levels, creates barriers to or limits access to harvesting areas, adds runoff to a watercourse, involves excavation)?	
If you answered “yes” to any of the above, please provide details. 

AC.2: Has another federal, provincial or territorial government entity indicated that Aboriginal consultation is required for this project? 	
Yes 	Please specify.	
No  		
Unknown  		

AC.3.1: Has the province (or territory) been in contact with any Aboriginal groups regarding this project?	
Yes 	Please provide a summary of the consultation activities completed to date.  If available, please provide details such as if any concerns were raised by Aboriginal groups, the nature of the concerns raised, and include in an attachment any information that may be useful (e.g. consultation plan, consultation summary, contact information, letters, emails, public notices, and any other types of communications).	
No  		

AC.3.2: Have you been in contact or plan to contact any Aboriginal groups regarding this project?	
Yes 	Please provide a summary of the consultation activities completed to date.  If available, please provide details such as if any concerns were raised by Aboriginal groups, the nature of the concerns raised, and include in an attachment any information that may be useful (e.g. consultation plan, consultation summary, contact information, letters, emails, public notices, and any other types of communications).	
No  		

AC.4:  Involvement of the Crown -
Other Federal or Provincial Departments or Agencies may be involved in the project (e.g., if a permit, authorization, land transfer agreement, lease, etc. is required ),  such as, but not limited to: 
The purpose of this section is to identify if other federal or provincial departments or agencies may be undertaking Aboriginal consultation activities as a result of their involvement in the project (e.g., issuing a permit and/or authorization).

If other authorities are involved, it is important to identify them, and to describe their role, particularly if they have to issue or have issued a permit and/or authorization. This is necessary for a number of reasons: to avoid procedural duplication, to enable the coordinated actions of the various authorities involved and to avoid submitting unnecessary repetitive requests to the Aboriginal groups concerned.

The information provided about the authorities and their actual or potential involvement in the project will help INFC to confirm their collaboration as early on in the process as possible.
	
Yes 	No  	Unknown 	Fisheries and Oceans Canada (e.g. Fisheries Act)	
Yes 	No  	Unknown 	Transport Canada (e.g. Navigation Protection Act)	
Yes 	No 	Unknown 	Natural Resources Canada (e.g. Explosives Act)	
Yes 	No  	Unknown 	Environment Canada (e.g. Species at Risk Act, Migratory Birds Convention Act, Canadian Environmental Protection Act)	
Yes 	No  	Unknown 	Parks Canada Agency	
Yes 	No  	Unknown 	Other departments (e.g. federal department, provincial department, funding department, …)
If applicable, please identify the federal department or agency and approval required.	
If you answered “yes” to any of the above, please describe the involvement of the identified department(s)/agency(s) in detail. 

Please provide contact information for each department identified so INFC can coordinate with them to avoid delays and duplication.	

AC.5: Provincial (or territorial) permits	
Please list all provincial (or territorial) permits that will be required for the project.
Please provide contact information for each department already contacted so INFC can coordinate with them to avoid delays and duplication. 	

Declaration of Information

Please check boxes to acknowledge you understand and/or agree to the following statements: 	
 INFC may have a duty to consult and, where appropriate, accommodate aboriginal groups, when the Crown contemplates conduct (such as providing funding) that might adversely impact potential or established Aboriginal or Treaty rights. INFC will rely to the extent possible on other processes that included Aboriginal consultation (e.g., a provincial environmental assessment process). However, it is understood that INFC may delegate certain procedural responsibilities to the proponent and the proponent will assist or carry out various aspects of consultation (e.g., the gathering of information). Note that a Proponent Guide and Toolkit for Aboriginal Consultation Process will be provided at the appropriate time. 

 It is understood that INFC may not enter into a contribution agreement until such time as INFC has determined that its Aboriginal consultation obligations have been met.

  I hereby certify that the information provided is accurate to the best of my knowledge and I understand that inaccurate information may result in the requirement for additional environmental and/or aboriginal consultation review.

Questionnaire completed by: ______________________________________________________

Signature:  _____________________________________________________________________

Date: _______________________________________________________________________

Additional Links	
Complete versions of the various acts outlined in this document please copy and paste these links into your browser.
•	Oceans Act-http://laws-lois.justice.gc.ca/PDF/O-2.4.pdf
•	Wild Life Regulation-http://laws-lois.justice.gc.ca/PDF/O-2.4.pdf
•	Migratory Bird Sanctuary-http://laws-lois.justice.gc.ca/PDF/C.R.C.,_c._1036.pdf
•	Regulations Designating Physical Activities-http://laws-lois.justice.gc.ca/PDF/C.R.C.,_c._1036.pdf
•	Prescribed Information for the Description of a Designated Project Regulations- http://laws-lois.justice.gc.ca/PDF/SOR-2012-148.pdf