TRASH DATA FORM

IMPORTANT TIPS:
 COLLECT TRASH WHICH YOU CAN CARRY AND
HERE HOW IT WORKS:
COUNT
 SEGREGATE EACH ITEM FIRST BEFORE COUNTING
 RECORD ONLY THOSE ITEM IN THE DATA FORM
 BE SURED OTHER REQUIRED INFORMATION IN FILED IN

CLEAN UP TRASH ORGANIZE

PUBLISH REDUCE
11 AND 21 AND 31 RESULTS
41 IMPACT
COLLECT DATA ANALYZE DATA
1 1 1 1

CLEANUP SITE INFORMATION

CLEAN UP SITE NAME BARANGAY CITY / MUNICIPALITY PROVINCE

TYPEOF CLEAN UP (CHECK THE BOXES BELOW)

BEACH/ RIVER / LAKE/ INLAND
UNDERWATER WATERCRAFT
SHORES WATERWAY (NO WATER)

DATE CLEAN UP MOST UNIQUE ITEM COLLECTED

NO. OF VOLUNTEERS WORKING TOTAL (INDICATE NO. OF EACH ITEM)
ON THIS FORM CHILDREN
(12 YRS. OLD & BELOW

NAME OF GROUP’S EMAIL ADDRESS MOBILE NO.

COORDINATOR

NAME OF SCHOOL / CLUB /

ORGANIZATION / COMPANY

NO NAME OF VOLUNTEERS AGE NO NAME OF VOLUNTEERS AGE

1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
IMPORTANT TIPS: NOTE: PLEASE RETURN THIS FORM
 COLLECT TRASH WHICH YOU CAN CARRY AND
COUNT IMMEDIATELY TO YOUR AREA / SITE
 SEGREGATE EACH ITEM FIRST BEFORE COUNTING COORDINATOR.
 RECORD ONLY THOSE ITEM IN THE DATA FORM
 BE SURED OTHER REQUIRED INFORMATION IN FILED IN
 TRASH DATA FORM
CLEAN UP SUMMARY TOTAL
NO. OF TRASH ESTIMATED ESTIMATED DISTANCE
BAG IN FILL WEIGHT KILOGRAMS CLEANED KILOMETERS

MOST LIKE TO FIND ITEMS TOTAL FISHING GEAR TOTAL

NO. NO.
CIGARETTE BUTTS FISHING BUOYS / TRAPS

FOOD WRAPPERS FISHING NETS & PIECES

(COFFEE/MILK/SUGAR/SALT/OIL/VINEGAR/SOY
SACHETS/CANDY/CHIPS/BISCUITS/ ETC.) ROPE (1 YARD/METER = 1 PIECE)
TAKE OUT / AWAY CONTAINERS (PLASTICS) FISHING LINE (1 YARD/METER = 1 PIECE)
BOTTLE CAPS (PLASTIC) PACKAGING MATERIALS TOTAL
BOTTLE CAPS (METAL) NO.
6 PACK HOLDERS
LIDS (PLASTIC) OTHER PLASTIC/FOAM PACKAGING
STRAWS/STIRRERS (SHAMPOO/SOAP/DETERGENT/TOOTHPASTE/FRUIT
NET/STYROFOAM FROM APPLIANCES / ETC.)
FORKS/KNIVES/SPOONS (PLASTIC) OTHER PLASTIC BOTTLES (PLASTIC)
BEVERAGE BOTTLES (PLASTIC) (WATER/SOFT TABACCO / CIGARETTE PACKAGING
DRINK)
/ WRAPPERS
BEVERAGE BOTTLE (GLASS) (WATER/SOFT PERSONAL HYGIENE TOTAL
DRINK/ALCOHOL)
NO.
BEVERAGE CANS
CONDOMS
GROCERY BAGS (PLASTIC)
SYRINGES
OTHER PLASTIC BAGS DIAPERS
PAPER BAGS TINY TRASHES LESS THAN 2.5 CM (SIZE
SMALLER THAN 25 CENTAVO COIN)
CUPS & PLATES (PAPER)
FOAM (PIECES)
CUPS & PLATES (PLASTIC) PLASTIC (PIECES)
CUPS & PLATES (FOAM) GLASS (PIECES)

OTHER TRASH TOTAL OTHER TRASH TOTAL

NO. NO.
APPLIANCES (TV / REFS / RADIO / COMPUTER / CONSTRUCTION MATERIALS (WOODS/
ETC.) (NOTE: WHOLE NOT PICE) BARS / NAILS / BRUSH / ETC.)
BALLOONS FIREWORKS
CIGAR TIPS (NOTE: THIS ARE NOT CIGARETTE BUTTS) TIRES (WHOLE NOT PIECES)
CIGARETTE LIGHTERS SHOES / SLIPPERS

LIST OF DEAD / INJURED WILD LIFE STATUS (DEAD OR INJURED) ENTANGLED CAUSE OF
(YES OR NO) ENTANGLEMENT
(LINE / NET / PLASTICS
TRASH DATA FORM