SITE SCREENING RECORD

Jurisdiction:
Parcel ID(s), stored as text:
Proposed use and minimum requirements:
Boundary source and source date:
Date checked:

For EACH of acreage, zoning, flood, wetlands, access, utilities:
Question:
Observed fact (or Unknown):
Evidence kind: Observed record / Assumption / Unknown
Source URL / document and page:
Source date (or Unknown):
Date checked:
Confidence and reason:
Limitations / unresolved evidence:
Next action:
Responsible person:

Decision: Investigate / Hold / Pass
Reason:
Assumptions that could change this decision:
Next review date:

HANDOFF TO FULLER REVIEW
Decision the next reviewer needs to support:
Question that could change the screening decision:
Evidence, document, or provider/agency response needed:
Responsible person or professional:
Target follow-up date:
Response received, date, scope, and conditions (or Unknown):
Change to the screening decision after that response:

Desktop mapping does not establish legal boundaries, regulatory jurisdiction,
utility capacity, access rights, or development approval.