Adopt-A-Highway Cleanup Report Form

Fill out the information below within one week after your pickup in order to receive credit for your efforts. Your participation cannot be credited until this information is received.

Group Name*
Group Leader or Contact Person*
First Last
County*
Phone*
Email*
Section of Road Cleaned*
Name of road(s) and/or Beginning and Ending Mile Points
Date Cleaned*
MM slash DD slash YYYY
Total Number of Hours Worked*
Total Miles Cleaned*
Total Number of Volunteers*
The total number of volunteers that assisted with this particular cleanup.
Total Bags Filled*
Total Weight of the Bags*
Did your group complete a safety meeting before your cleanup began?*
Did your group separate the recyclables from the littered items?*
Other notes from your cleanup
Please list any comments or concerns about your cleanup.
Pictures
Upload documents, photos, or video files related to your cleanup. You may share up to 5 files.
Drop files here or

Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, mp3, mp4, m4a, zip, tif, tiff, png, wpf, odt, wav, mov, xls, wpd, ppt, pptx, avi, mpg, xlsx, sib, mus, 3gp, flv, webm, psd, ai, mobi, epub, wmv, eps, key, ogg, aac, flac, aiff, wma, mkv, musx, ibooks, iba, tex, bbl, ltx, m4v, svg, fdx, dwg, vsd, vss, vst, vdx, vsx, vtx, mpp, mpx, Max. file size: 5 MB, Max. files: 5.

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