End of Clean Up Report
Please complete the information below about your Clean Up event. The first part of the survey will collect information about your Clean Up site. The second part of the survey will collect information about the rubbish you have collected.

Please make sure to submit your form before exiting.

If you aren't completing Section 2, please scroll to the bottom of the next page and click submit to make sure we receive your information. You can edit your information after submitting if you need to complete or edit information later on.

Email address *
Before you start
Section 2 will ask you to provide information about the rubbish you collected at your event. We'll ask for information about the following categories in order:

1. Plastic Bags
2. Plastic Bottles and Containers Section
3. Plastic Miscellaneous Section
4. Polystyrene Foam Section
5. Glass Section
6. Rubber Section
7. Paper/Cardboard Section
8. Metal and Aluminium Cans Section
9. Wood Section
10. Miscellaneous Section

We recommend sorting the rubbish into these categories to make filling out Section 2 easier.

Type of Clean Up
Site Number
Your answer
Site Name
Your answer
Site Supervisor Name
Your answer
Site Supervisor Email
Your answer
Group or Organisation Name
Your answer
Site Address
Your answer
Town/Suburb
Your answer
State
Postcode
Your answer
Event Date
MM
/
DD
/
YYYY
Start Time
Time
:
End Time
Time
:
Council Name
Your answer
Location Type
Recurring Clean Up
Recurring Frequency
Site Category
Please specify site type if other
Your answer
Number of Volunteers
Your answer
Number of Adults
Your answer
Number of Children (Under 16)
Your answer
Number of Males
Your answer
Number of Females
Your answer
Did an accident/incident occur at your Clean Up Site?
Were any syringes found at your site?
Approximate number of syringes found
Your answer
Does this site attract illegal dumping?
Number of Clean Up (or similar) bags collected at your site?
Your answer
Number of Clean Up (or similar) bags opened and counted for Part 2 of the Survey?
Your answer
Estimated Total Area of Site (m2 or km2)
Your answer
Approx. weight of rubbish collected in bags surveyed
Your answer
Any interesting or unusual items collected?
Your answer
Did you recycle any rubbish?
Please specify other recycled items
Your answer
Most Significant Change
Please take time to tell us about significant changes that have occurred as a result of your participation this year.
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service