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SEPA document templates (forms)

The following templates are based on applicable SEPA rule sections and other guidance materials. Lead agencies are encouraged to modify these templates for their own use and add information for clarification and completeness. 

SEPA templates

The list below provides some sample SEPA document templates that can be downloaded. Please note that SEPA lead agencies may have their own versions. This means private applicants should check with the particular lead local or state agency reviewing their proposal.

Lead agencies: Please include your letterhead or agency title at the top of these templates when you distribute for review.

Templates Format
Environmental Checklist with added help links and instructions  doc pdf
Determination of Nonsignificance (DNS)  doc pdf
Mitigated Determination of Nonsignificance (MDNS) doc pdf
Determination of Significance/EIS Scoping Notice (DS) doc pdf
Sample Notice of Application with Optional DNS (NOA/ODNS) doc pdf
Determination of Significance and Adoption of Existing Environmental Document doc pdf
Determination of Nonsignificance and Adoption of Existing Environmental Document doc pdf
Notice of Action Taken (NAT)  doc pdf
Revised Determination of Nonsignificance doc pdf
SEPA Withdrawal Notice  doc pdf
Notice of Assumption of Lead Agency Status  doc pdf
Optional Worksheet for NonProject Review doc pdf