BOEM-0142 Environmental Impact Analysis Worksheet

U.S. Department of the Interior

OMB Control Number: 1010-0151
OMB Approval Expires: xx/xx/2021

Bureau of Ocean Energy Management

ENVIRONMENTAL IMPACT ANALYSIS WORKSHEET
Identify the IPF’s that can cause impacts to the listed environmental resources by placing an “x” in the space under
each IPF category associated with your proposed activities that may impact a particular environmental resource. If
you determine an IPF would not impact a particular environmental resource, leave the space blank. For those cells
that are footnoted, provide a statement as to the applicability to your proposed operations, and, where there may be an
effect, provide an analysis of the effect. If you are aware of other environmental resources at or near your activity’s
site that are not included on the worksheet, address them too.
Environmental
Resources

Site-specific at Offshore
Location
Designated topographic
features
Pinnacle Trend area live
bottoms
Eastern Gulf live bottoms
Chemosynthetic communities
Water quality
Fisheries
Marine mammals
Sea turtles
Air quality
Shipwreck sites (known or
potential)
Prehistoric archaeological sites

Impact Producing Factors (IPFs)
Categories and Examples
Refer to a recent GOM OCS Lease Sale EIS for a more complete list of IPFs
Emissions
Effluents (muds,
Physical
Wastes
Accidents
Other
(air, noise, cuttings, other
disturbances
sent to
(e.g., oil spills, IPFs
light, etc.)
discharges to the to the seafloor
shore for
chemical
you
water column or
(rig or anchor
treatment
spills, H2S
identify
seafloor)
emplacements,
or disposal releases)
etc.)

(1)

(1)

(1)

(2)

(2)

(2)

(3)

(3)
(4)

(3)

(8)
(8)

(8)
(8)
(9)
(7)
(7)

Vicinity of Offshore Location
Essential fish habitat
Marine and pelagic birds
Public health and safety
Coastal and Onshore
Beaches
Wetlands
Shore birds and coastal nesting
birds
Coastal wildlife refuges
Wilderness areas

(6)
(5)
(6)
(6)
(6)

Other Resources You
Identify

NOTE: The numbers in parentheses refer to the footnotes on page 2 of this form.

BOEM FORM 0142 (Month 2018 - Supersedes all previous editions of this form which may not be used)

Page 1 of 2

Footnotes for Environmental Impact Analysis Matrix

1. Activities that may affect a marine sanctuary or topographic feature. Specifically, if the well or platform site or
any anchors will be on the seafloor within the:
(a) 4-mile zone of the Flower Garden Banks, or the 3-mile zone of Stetson Bank;
(b) 1000-m, 1-mile or 3-mile zone of any topographic feature (submarine bank) protected by the Topographic
Features Stipulation attached to an OCS lease;
(c) Essential Fish Habitat (EFH) criteria of 500 ft from any no-activity zone; or
(d) Proximity of any submarine bank (500 ft buffer zone) with relief greater than 2 meters that is not protected by
the Topographic Features Stipulation attached to an OCS lease.
2. Activities with any bottom disturbance within a OCS lease block protected through the Live Bottom (Pinnacle
Trend) Stipulation attached to an OCS lease.
3. Activities within any Eastern Gulf OCS block where seafloor habitats are protected by the Live Bottom (LowRelief) Stipulation attached to an OCS lease.
4. Activities on blocks designated by the BOEM as being in water depths 400 meters or greater.
5. Exploration or production activities where H2S concentrations greater than 500 ppm might be encountered.
6. All activities that could result in an accidental spill of produced liquid hydrocarbons or diesel fuel that you
determine would impact these environmental resources. If the proposed action is located a sufficient distance
from a resource that no impact would occur, the EIA can note that in a sentence or two.
7. All activities that involve seafloor disturbances, including anchor emplacements, in any OCS block designated by
the BOEM as having high-probability for the occurrence of shipwrecks or prehistoric sites, including such blocks
that will be affected that are adjacent to the lease block in which your planned activity will occur. If the proposed
activities are located a sufficient distance from a shipwreck or prehistoric site that no impact would occur, the EIA
can note that in a sentence or two.
8. All activities that you determine might have an adverse effect on endangered or threatened marine mammals or sea
turtles or their critical habitats.
9. Production activities that involve transportation of produced fluids to shore using shuttle tankers or barges.

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501et seq.) requires us to inform you
that BOEM collects this information as part of an applicant’s Exploration Plan (EP) or Development Operations
Coordination Document (DOCD) submitted for BOEM approval. We use the information in our review and data
entry for OCS plans. Reponses are mandatory (43 U.S.C 1334). We will protect proprietary data according to the
Freedom of Information Act and 30 CFR 250.197. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid Office of Management and
Budget Control Number. The public reporting burden for this form is included in the burden for preparing EPs and
DOCDs. We estimate that burden to average 600 hours per response for EPs and 700 hours per response for DOCDs,
including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the forms
associated with subpart B. Direct comments regarding the burden estimate or any other aspect of this form to the
Information Collection Clearance Officer, Bureau of Ocean Energy Management, Regulation and Enforcement, 45600
Woodland Road, Sterling, Virginia 20166.

BOEM FORM 0142

(Month 2018 - Supersedes all previous editions of this form which may not be used)

Page 2 of 2