In the intricate landscape of environmental and conservation efforts within the State of California, the California Conservation Corps (CCC) plays a crucial role, one that is meticulously outlined through the CCC-58 Form, a key document foundational to project evaluation. Structured to capture comprehensive details, the form encapsulates multiple facets ranging from project data to sponsor information, and emergency response specifics, painting a clear picture of the project’s scope, objectives, and logistics. Essential for the thorough assessment and seamless execution of conservation projects, the CCC-58 Form covers not only the administrative angles, including contract details and organizational contacts but also dives into the operational depth of location directives, equipment needs, and educational activities planned. Furthermore, it places a significant emphasis on ensuring that projects align with legislatively mandated objectives concerning natural resource conservation, public benefit, and skill training for Corpsmembers. This multifaceted approach ensures that every conservation effort under the CCC’s purview is well-documented, meticulously planned, and rigorously evaluated to meet the high standards set for environmental stewardship and community service in California.
| Question | Answer |
|---|---|
| Form Name | Form Ccc 58 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | 2medium, CDF, CCC-96A, vistor |
STATE OF CALIFORNIA
PROJECT EVALUATION FORM
[A]PROJECT DATA
Project/Work Code: Contract:
Project Title: Project Description:
Center Code:
Hourly/Performance:
CALIFORNIA CONSERVATION CORPS
Page 1 of 3
Center:
Resource Category:
SAMPLE COPY ONLY
Project Evaluator:
Date:
[B] SPONSOR INFORMATION
Agency Code: |
Sponsor Organization: |
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Address: |
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City: |
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State: |
ZIP: |
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Sponsor Representative: |
Title: |
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Phone: |
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Technical Supervisor: |
Title: |
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Phone: |
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[C] EMERGENCY RESPONSE INFORMATION
CDF Incident #:
CCC Index #:
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CDF Req #: |
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OES #: |
HQ Ref #: |
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Corpsmember Overtime Pay Serial #: |
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[D]ESTIMATE INFORMATION
Hours: Start Date:
[E]WORKSITE INFORMATION
Directions to Worksite Location:
ZIP:
[F] FOR HQ USE ONLY (initial and date)
County Code:
County:
Received: |
Logged: |
Verified: |
Analyst: |
Entered: |
Checked: |
STATE OF CALIFORNIA |
CALIFORNIA CONSERVATION CORPS |
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PROJECT EVALUATION FORM |
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[G] EDUCATIONAL ACTIVITIES scheduled during the work day. |
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SPONSOR: Educational presentation to increase Corpsmember understanding of the natural environment
Length of time scheduled:
CCC: The CCC will be doing the following work/learn activities.
Length of time scheduled:
[H] EQUIPMENT & MATERIALS
To be supplied by SPONSOR: |
To be supplied by CCC: |
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Qty |
Description |
Qty |
Description |
Special SPIKE equipment needed by crew:
SPIKE Information (description and location of housing):
STATE OF CALIFORNIA |
CALIFORNIA CONSERVATION CORPS |
PROJECT EVALUATION FORM |
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[I]NARRATIVE ON HOW PROJECT WILL MEET ALL LEGISLATIVELY MANDATED OBJECTIVES (Assign a numerical rating: 1=low, 2=medium, 3=high)
Conserving, improving, developing natural resources, maintaining environmentally important lands or waters:
RATING:
Providing public benefit or access (Estimated vistor use, increased safety, reduced maintenance costs, etc.):
RATING:
Providing Corpsmembers with opportunities for training in employable skills (e.g. specific tools and use, fire control, carpentry):
RATING:
[J] PROJECT CHECKLIST & SIGNATURE BLOCKS
IN SIGNING THIS DOCUMENT, THE PROJECT COORDINATOR AND CONSERVATION SUPERVISOR VERIFY THAT:
G A
G If a reimbursable project, a
G The project conforms to CCC Health & Safety Program guidelines (Section
GA
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Project Coordinator: |
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Date: |
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Conservationist Supervisor: |
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IN SIGNING THIS DOCUMENT THE SPONSOR VERIFIES THAT (check one box):
1.G They have provided the location, identity, and amounts of any hazardous substances at the worksite on an attached sheet and have provided all appropriate Material Safety Data Sheets for hazardous materials that are present at the worksite.
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G that to the best of their knowledge the worksite is free of any known hazardous materials (such as residues from |
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pesticide applications, storage of solvents, and spills of hazardous substances.) |
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2. |
AND that all applicable local, state, and federal permits approvals, and clearances have |
been obtained. |
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Sponsor Representative: |
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Print: |
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Sign: |
Date: |
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