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