Personal Care Waste Assessment - Edit & Update As Needed
Use this form to assess your waste from your bathroom waste basket. Look through your waste baskets and mark off all items found. Use the "Other" Section below the list provided to note your waste items not included in the list.

When you are done or want to stop, click on the "Submit" button at the bottom of the page.

You may use the results to identify items you want to stop using. You may also want to look for alternatives such as replacing with reusables; or you may look to other solutions such as re-using, re-purposing, recycling or composting. Use the "My Solutions" section to note the items you want to work on, the solutions you try and their success.

You may come back to this assessment and continue to mark off items as you throw away trash, identify new items and identify new solutions. Look for an email after each time you change your assessment and flag/mark the email so you may find it easily. Just click on the link in the email to edit and update your responses. You may also bookmark the form after the first submission to allow you quick access edit your form.

As you implement solutions and eliminate a waste item, you may un-check the box to reflect that it is no longer a waste item for you.

Privacy Notice: We will not disclose your personal information such as name and email address nor will we share the results of your assessments without your prior authorization.

(This form was created by TheGentleLife.com - Please contact us if you need assistance with this form.)
Email address *
First and Last Name *
Your answer
Personal Care Waste
Check off all items found in your bathroom waste basket. Feel free to add items under "Other" not included in the list.
Other Personal Care Waste Not Listed Above
Your answer
My Solutions
Identify the items you want to work on below by writing in the name of the waste item and the solution you want to try to reduce or eliminate the waste item. Your solution may be to stop purchasing that item altogether or it may be to switch to something new. You might also consider re-using, re-purposing, re-cycling or composting. You may also track the success of each solution here.
Solution #1
Your answer
Track Success for Solution #1
Not Working For Me
Great Success!
Solution #2
Your answer
Track Success for Solution #2
Not Working For Me
Great Success!
Solution #3
Your answer
Track Success for Solution #3
Not Working For Me
Great Success!
Solution #4
Your answer
Track Success for Solution #4
Not Working For Me
Great Success!
Solution #5
Your answer
Track Success for Solution #5
Not Working For Me
Great Success!
Solution #6
Your answer
Track Success for Solution #6
Not Working For Me
Great Success!
Solution #7
Your answer
Track Success for Solution #7
Not Working For Me
Great Success!
Solution #8
Your answer
Track Success for Solution #8
Not Working For Me
Great Success!
Solution #9
Your answer
Track Success for Solution #9
Not Working For Me
Great Success!
Solution #10
Your answer
Track Success for Solution #10
Not Working For Me
Great Success!
Solution #11
Your answer
Track Success for Solution #11
Not Working For Me
Great Success!
Solution #12
Your answer
Track Success for Solution #12
Not Working For Me
Great Success!
Solution #13
Your answer
Track Success for Solution #13
Not Working For Me
Great Success!
Solution #14
Your answer
Track Success for Solution #14
Not Working For Me
Great Success!
Solution #15
Your answer
Track Success for Solution #15
Not Working For Me
Great Success!
Solution #16
Your answer
Track Success for Solution #16
Not Working For Me
Great Success!
Solution #17
Your answer
Track Success for Solution #17
Not Working For Me
Great Success!
Solution #18
Your answer
Track Success for Solution #18
Not Working For Me
Great Success!
Solution #19
Your answer
Track Success for Solution #19
Not Working For Me
Great Success!
Solution #20
Your answer
Track Success for Solution #20
Not Working For Me
Great Success!
Solution #21
Your answer
Track Success for Solution #21
Not Working For Me
Great Success!
Solution #22
Your answer
Track Success for Solution #22
Not Working For Me
Great Success!
Solution #23
Your answer
Track Success for Solution #23
Not Working For Me
Great Success!
Solution #24
Your answer
Track Success for Solution #24
Not Working For Me
Great Success!
Solution #25
Your answer
Track Success for Solution #25
Not Working For Me
Great Success!
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy