d d / m m / y y Please mark event type and date. Event Type : Event Date : FOR INFORMATION CALL TOLL FREE 1800 CUA DAY / 1 800 282 329 OR VISIT CLEANUP.ORG.AU Community Primary School Youth (including High School) Business Start Time: Finish Time: END OF CLEAN UP REPORT PLEASE POST OR SCAN AND INCLUDE THE VOLUNTEER REGISTRATION FORM CLEAN UP AUSTRALIA SUITE 701, LEVEL 7, 140 ARTHUR ST, NORTH SYDNEY NSW 2060 OR SCAN AND EMAIL TO: [email protected]AM/PM AM/PM Rubbish Summary No. of full Clean Up (or similar) bags collected at your Site: No. of Clean Up (or similar) bags opened and counted for Part 2 of the rubbish survey (pages 2-4): Approx. weight of rubbish collected in bags surveyed: kg Any interesting or unusual items collected? Yes No Did you separate these recyclables? If ‘Yes’, please indicate items recycled: Aluminium Glass Other (specify): Most Significant Change Please take time to tell us about significant changes that have occurred as a result of your participation this year. Clean Up Site Details Complete one End of Clean Up Report per site Site Supervisor name: Site Number or Name: Group/Organisation/School name: Site address: Town/Suburb: State: Postcode: Council area: Site category (please tick one box only) River/Creek Beach/Coastal Public Bushland School Grounds/Campus Dive Site National Parks Parks Roadside Footpath Shops/Malls Outdoor Public Transport Other _________________ Volunteers (estimate) No. of volunteers incl supervisors: No. of adults: No. of children (under 16): No. of males: No. of females: Other: Your Clean Up event Did an accident/incident occur at your Site? Yes No If ‘Yes’, please complete and return an Accident/Incident Report Form to Clean Up Australia. Were any syringes found at your Site? Yes No Approx no. Does this Site attract illegal dumping? i.e. cars/whitegoods Yes No PART 1 ACTIVITY SUMMARY This first page provides an overview of the results of your Clean Up Activity. Plastics Paper/Cardboard Steel Yes No Did you return beverage containers?
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d d / m m / y yPlease mark event type and date. Event Type :
Event Date :
FOR INFORMATION CALL TOLL FREE 1800 CUA DAY / 1 800 282 329 OR VISIT CLEANUP.ORG.AU
CommunityPrimary School Youth (including High School)Business
Start Time:Finish Time:
END OF CLEAN UP REPORT
PLEASE POST OR SCAN AND INCLUDE THE VOLUNTEER REGISTRATION FORM CLEAN UP AUSTRALIA SUITE 701, LEVEL 7, 140 ARTHUR ST, NORTH SYDNEY NSW 2060OR SCAN AND EMAIL TO: [email protected]
AM/PMAM/PM
Rubbish SummaryNo. of full Clean Up (or similar) bags collected at your Site:
No. of Clean Up (or similar) bags opened and counted for Part 2 of the rubbish survey (pages 2-4):
Approx. weight of rubbish collected in bags surveyed: kg
Any interesting or unusual items collected?
Yes NoDid you separate these recyclables?If ‘Yes’, please indicate items recycled:
Aluminium
Glass
Other (specify):
Most Significant ChangePlease take time to tell us about significant changes that have occurred as a result of your participation this year.
Clean Up Site DetailsComplete one End of Clean Up Report per site
Site Supervisor name:
Site Number or Name:
Group/Organisation/School name:
Site address:
Town/Suburb:
State: Postcode:
Council area:
Site category (please tick one box only)
River/Creek Beach/Coastal Public Bushland School Grounds/Campus Dive Site National Parks
ParksRoadsideFootpathShops/MallsOutdoor Public Transport Other _________________
Volunteers (estimate)No. of volunteers incl supervisors:
No. of adults: No. of children (under 16):
No. of males: No. of females: Other:
Your Clean Up eventDid an accident/incident occur at your Site?
Yes NoIf ‘Yes’, please complete and return an Accident/Incident Report Form to Clean Up Australia.
Were any syringes found at your Site?Yes No Approx no.
Does this Site attract illegal dumping? i.e. cars/whitegoodsYes No
PART 1 ACTIVITY SUMMARYThis first page provides an overview of the results of your Clean Up Activity.
PlasticsPaper/Cardboard Steel
Yes NoDid you return beverage containers?
Rubbish Type No. of items (tally mark) Total Are these recyclable in your area? EXAMPLE Yes No Unsure chips & confectionery I I I I 4 ✔
Soft plastics (i.e. scrunchable)
chips & confectionery bags
food bags
garbage/rubbish bags
supermarket/retail bags
other soft plastics (specify)
Plastic bottles / containers
automotive oils
food (sauces etc)
milk
laundry/cleaningPET drink containers
fruit juice
non PET containersother plastic btls/ctns (specify))
• This survey requires you to identify and count a proportion ofthe rubbish collected at your Site and record the results.To make it easier, work in teams of two.
• When you separate recyclable items from rubbish items intodifferent bags, please capture a representative sample fromboth types of bags – that is, if your site collects 10 rubbishbags and 5 recyclable bags, count the items from 2 rubbishbags and 1 recyclable bag.
• We suggest you count the rubbish collected in every 5th bag.Stop when you have surveyed 6 bags in total.If you collect just 5 bags of rubbish, survey the contents of just1 bag.
• Thank you for taking the time to complete this report. Yourfeedback helps ensure the ongoing success of the campaign.
Items commonly recyclable through kerbside collections. Items which are specialist recyclable. For additional information please refer to the ‘Guide to rubbish items’ in the Site Guide.
PART 2 RUBBISH SURVEY continuedThis section of the form is optional. The collection of this information enables us to access valuable statistical data from activities conducted nationally and forms the basis of our annual Rubbish Report. Please read the instructions below before starting the survey. Data is also shared with state & federal agencies such as the CSIRO to assist with litter mapping.
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cling wrap
Rubbish Type No. of items (tally mark) Total Are these recyclable in your area? Yes No Unsure
Polystyrene foam
cups/platesfast food containerspackagingpieces
other polystyrene (specify)
Glassalcoholic beverage bottles
food jarspieces
soft drink bottles
fruit juice bottleslight globeother glass (specify)