Event Reporting Form

Please complete all fields and then click the "Submit" button.

Do not use the 'Enter' key until you have completed the form. Any field with an Asterisk (*) is required

When was Your Event?

Date & Time

Did you get Parental Consent Waivers signed? (upload documents)

Did you get Volunteer Waivers signed? (upload documents)

Upload images and/or documents of your event

JPG,PNG, or PDF only

I authorize Keep Pennsylvania Beautiful, its assigns and transferees to copyright, use and publish the uploaded photos in print and/or electronically. I agree that Keep Pennsylvania Beautiful may use such photographs (of me or of all participants) with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, social media and web content to advance the mission of the organization.

Drag & Drop Files Here

Drop file here to upload

Report

Reported Number of Volunteers

Cleanup location/site description?

Event Location Description

Waterway

County Event held in:

You can move the flag on the map to the exact location of the cleanup.

Nearest Roadway Landmark

Overall was trash observed

Litter

Illegal Dumping

Event Summary

How long were you working/recreating(total minutes)

Distance Covered

RIPARIAN BUFFER

No vegetation/eroded bank

Partially vegetated with grass/shrubs

Well vegetated with mature trees

Buffer Zone Width

>18

12-18 Meters

Well vegetated with mature trees

<6 meters

Was trash observed in the buffer zone?
Approx. percentage of trash removed was from the buffer zone?

STREAM HEALTH ASSESSMENT

Air Temp in ℉

Stream Flow

High

Low

Normal

Recent Precipitation

Visible Human Distubances Noted

Water Clarity

Clear

Murky

Stream Life

Frogs Salamanders Turtles Fish

Invasive species present

Other observations noted

Report Notes