Thanks for being such an important part of helping our community understand the impact of substances like tobacco, nicotine, alcohol, cannabis vapes, and other substances. Your participation helps us continue the conversation and better address these issues. Feel free to share this information with others, as every effort counts in keeping our community healthy and safe!

Please be specific when completing this survey. Keep a count of how many substance-related items you find and where you find them.

You can also take pictures of what you find and email them to alison@healthylamoillevalley.org. Please do not send pictures of anyone underage holding the products. By sharing your images, you give Healthy Lamoille Valley and Lamoille Family Center permission to use them.

We recommend wearing gloves and ensuring youth are working with an adult. Please do not collect anything that could harm you, and take extra precautions as needed. If you see needles, do not touch them - please notify local law enforcement for the best method of disposal.

If you have any questions, please contact Healthy Lamoille Valley Policy & Outreach Coordinator Alison Link at alison@healthylamoillevalley.org.

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* 1. Your Name (optional)

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* 2. Your Email Address (optional)

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* 3. What was the date of this cleanup?

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* 4. Please list the town, streets, parks, or other geographic areas you’ve worked on during the cleanup.

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* 5. Was this connected to an organized cleanup or an individual effort?

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* 6. Was this a Green Up Day event or a different type of cleanup?

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* 7. Number of cigarette butts collected

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* 8. Number of vape devices and materials collected

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* 9. Number of small alcohol bottles (nips) found

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* 10. Number of alcohol bottles found

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* 11. Number of alcohol cans found

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* 12. Number of needles found and the location (DO NOT PICK UP! Please notify law enforcement for proper disposal)

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* 13. What type of substance-related items did you find the most during your cleanup?

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* 14. Was there a specific area with a high concentration of substance-related items? Please provide details. The more specific, the better!

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* 15. Are there locations in your area where you notice substance-related items being dumped throughout the year? Please provide details. The more specific, the better.

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* 16. Please share any other thoughts or questions you have with us. Thank you!

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