End of Clean Up Report 2021
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.
Sign in to Google to save your progress. Learn more
Email *
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. Soft Plastics
2. Plastic Bottles and Containers
3. Plastic (Miscellaneous)
4. Polystyrene Foam
5. Glass
6. Rubber
7. Paper and Cardboard
8. Metal and Aluminium Cans
9. Metal and Aluminium (Miscellaneous)
10. Wood
11. Miscellaneous

We recommend sorting the rubbish into these categories to make filling out Section 2 easier.
Event Date
Type of Clean Up
Clear selection
Site Supervisor Name
Site Number
Site Name
Group or Organisation Name
Site Address
Council Name
Site Category
Please specify site type if other
Number of Volunteers (including supervisor)
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 full 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?
Approx. weight of rubbish collected in bags surveyed (kg)
Any interesting or unusual items collected?
Did you recycle any rubbish?
Clear selection
If yes, select rubbish types:
Please specify any other recycled items:
Did you return beverage containers?
Clear selection
Most Significant Change
Please take time to tell us about significant changes that have occurred as a result of your participation this year.
If you have any suggestions for the team at Clean Up Australia, please let us know.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy