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: CLEANUP@CLEANUP.COM.AU

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))

Plastic miscellaneous

bottle caps & lids

cigarette lighters

packaging

containers (ice cream etc)

cutlery/cups/utensils

disposable nappies

fishing equipment

toys and sporting equipment

plastic crates (milk etc)

plastic rope (length=_______ m)

pvc piping (length=________ m)

sanitary pads/surgical dressings

six-pack rings/wrapping

straws

tapes/straps/fasteningsother plastic misc. (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.

SRR

SR

RRRRR

SR

R

SR

SR

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)

Rubber

condomsglovesthongs/shoestyresother rubber (specify)

Paper / cardboard

bagsboxescigarette packetscupsdrink cartonsmilk cartonsegg cartonsfast food packaging

napkins & tissuesnewspapers/books/magazineslarge papersmall paper

wine casksother paper/cardboard (specify)

Metal / aluminium cans

aerosolalcoholic beverage

soft drink

foodother metal/alum. cans (specify)

PART 2 RUBBISH SURVEY continued

SR

RRRRR

SR

RRRRRRRRRRRRRR

RRRR

RRRR

SR

SRSRSRSRSR

SR

SR

SR

SR

R

PART 2 RUBBISH SURVEY continued

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY

Rubbish Type No. of items (tally mark) Total Are these recyclable in your area? Yes No Unsure

Metal / aluminium miscellaneousappliancesbottle capsconstruction materialsfoil/confectionery wrappers

forty-four gallon drumspaint tinslarge metal piecespipe (length=________ m)small metal pieceswire (length=________ m) other metal/alum. misc (specify)

Woodconstruction materialsice cream stickspiecesbottle corks

other wood (specify)

Miscellaneousbatteriescar/machinery partscarpet (larger than this sheet)ceramicscigarette butts

clothinge-waste (mobiles, computers etc)food scrapsfurnitureshopping trolleyssyringesother miscellaneous (specify)