PITCH-IN CANADA Week
Land Pollution Counts

LAND POLLUTION COUNT DATA CARD
Questionnaire

• Location of Clean Up:		Circle one only per data card Urban Park                   Vacant Lot Schoolyard            Residential Area Commercial Area     Industrial Park Lanes                 Ravine                 Highway Wilderness Area or Trail Recreation/Sports Centre Other (specify)
  Province:		Community:
  Name of Area Cleaned:
  Date:	Month:	Day:	Year:
  Name of Event Coordinator:		Phone Number:
  Group/Position:
  Address:
  City:			Postal Code:
  Number of volunteers working together on this card:
  Estimated distance of area cleaned:
  Number of PITCH-IN bags filled:
  Total estimated weight:

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  SAFETY AND OTHER TIPS FOR YOUR VOLUNTEERS!
   

• Handle sharp objects and syringes with gloves on, carefully
• Wear gloves and proper shoes
• Be careful in wilderness areas and ravines
• Don't lift anything too heavy
• Watch out for traffic

More SAFETY TIPS on the PITCH-IN CANADA Web Site at www.pitch-in.ca

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To view and print the Plastic and Foamed Plastic Recording Forms please click here