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Proactive Disclosure

Proactive Disclosure

Request for Review under the Fish Habitat Protection Provisions of the Fisheries Act

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Please review the Proponent's Guide to Information Requirements for Review under the Fish Habitat Protection Provisions of the Fisheries Act for assistance related to the information requirements listed below.

In order to initiate a review of your development proposal, please provide the following information to Fisheries and Oceans Canada. Include the information in Sections A and B directly on the form. The information in Sections C and D can either be included on the form or, if more complex, can be included within the development proposal submission.

*NOTE: Please use the PDF version of the Form. The version below is displayed here for information purposes only. Please use the Alternate Format (.pdf) to fill out and send to DFO. Office contact information can be accessed from the Department's web site at www.dfo-mpo.gc.ca//habitat/regions/index-eng.htm.

A) Contact Information for Proponent, Contractor and Consultants

Name of Proponent:
Mailing Address:
City/Town:
Province/Territory:    Postal Code:
Tel. No. (Residence):    Tel. No. (Work):
Fax No:      Email Address:

NAME OF CONTRACTOR/AGENCY/CONSULTANT (if applicable):
Mailing Address:
City/Town:
Province/Territory:    Postal Code:
Tel. No. (Residence):    Tel. No. (Work):
Fax No:      Email Address:

B) Location of Proposed Development

Name of Nearest Community (City, Town, Village):
Municipality, District, Township, Country, Province
Name of Watercourse(s) or water body(ies) likely to be impacted by the proposed development.
Coordinates of the proposed development (e.g., map, Global Positioning System [GPS] or Universal Transverse Mercator Grid [UTM] coordinates)

Directions (showing access routes, i.e., water, air) to access the proposed development site. In a marine setting, it may be helpful to depict the approximate location of the proposed development on a nautical chart or showing the relation of the site to sea marks or other navigational aids. If there is insufficient space on the form please indicate where this information can be found in the attached development proposal.

C) Description of the Aquatic Environment
(This information can either be included on the form or, if more complex, can be included within the development proposal submission.)

C.1 Type of watercourse, water body
C.2 Biophysical characteristics of the site (Channel width, Type of flow, Tides, Water depth, Substrate type and density, Aquatic (freshwater, marine or estuary) vegetation type and density, Other aquatic organisms, Presence of fish species.)

C.3 Drawings or photographs of the aquatic environment. If there is insufficient space on the form please indicate where this information can be found in the attached development proposal.

D) Description of the Proposed Development
(This information can either be included on the form or, if more complex, can be included within the development proposal submission.)

D.1 Components of the proposed development
D.2 Methods, materials and equipment

D.3. Affected Area

D.4. Plans, maps or drawings

D.5. Fish and Fish Habitat Protection Measures

D.6. Implementation schedule

D.7. Life expectancy

I, _________________________________________ (print name) certify that the information given on this form is to the best of my knowledge, correct and completed.

________________________ _________________
Signature Date

Information about the above-noted proposed work or undertaking is collected by Fisheries and Oceans Canada under the authority of the Fisheries Act for the purpose of administering the fish habitat protection provisions of the Fisheries Act. Personal information will be protected under the provisions of the Privacy Act and will be stored in the Personal Information Bank DFO-PPU-080. Under the Privacy Act, individuals have a right to, and on request shall be given access to any personal information about them contained in a personal information bank. Instructions for obtaining personal information are contained in the Government of Canada’s Info Source publications available at www.infosource.gc.ca or in Government of Canada offices. Information other than “personal” information may be accessible or protected as required by the provision of the Access to Information Act.

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Proactive Disclosure

Request for Review under the Fish Habitat Protection Provisions of the Fisheries Act