Safe Grounds Syringe Clean-Up
Thank you for submitting a Safe Grounds request. Please allow our team 24-48 hours to receive your submission and work on cleaning up the site. You can reach us at admin@belowsealevelaid.com with any questions or concerns. 
Sign in to Google to save your progress. Learn more
Location of Syringes *

Street address, intersection, park, or neutral ground. Include any landmarks for easier identification.

Are the syringes in a high-traffic area? *

Example: sidewalk, playground, parking lot, street, park.

Approximate Quantity *
Choose size and number per color
Any other hazards or concerns at the site?

Broken glass, trash, animals, unsafe access, etc.

Preferred Contact Method for Follow-up

Text, call, or email.

Additional Notes
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report