I own a couple of the old screens, but have never seen this particular one before. If anyone knows which module it came bundled with, or the name of the product if it's a stand alone product, I'd be very grateful!
The Torchbearer GM screen
I'm pretty sure that is the Torchbearer screen, as seen in this image.
Torchbearer is a game based on the Burning Wheel system, written to evoke the real sense of danger and especially scarcity in dungeon-delving.