Significance Determination Worksheet

Activity Name:

Aspect Name:

Criteria

Score

If = 3
check box

a) Frequency of Aspect

b) Regulatory

c) Public Perception

d) Health Effects

e) Severity

f) Effect of Emergency

Total Score =

a. Frequency of Aspect:
     0 pts - None
     1 pt - Slight
     2 pts - Moderate
     3 pts - Extreme/Continuous

b. Regulatory:
     0 pts - No
     3 pts – Yes

c. Public Perception:
     0 pts - None
     1 pt - Slight
     2 pts - Moderate
     3 pts - Extreme/Continuous

d. Health Effects:
     0 pts - None
     1 pt - Slight
     2 pts - Moderate
     3 pts - Extreme/Continuous

e. Severity of Environmental Damage:
     0 pts - None
     1 pt - Slight
     2 pts - Moderate
     3 pts - Extreme/Continuous

f. Effects of Emergency Occurrence:
     0 pts - None
     1 pt - Slight
     2 pts - Moderate
     3 pts - Extreme/Continuous