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