Question Title

Image
Help us collect information about the impact of substances in our region!

Please be specific. Keep a count of how many substance-related items you find and where you find them. You can take pictures of what you find and upload them to this survey.

We recommend wearing gloves and that youth work with an adult. Please do not collect anything that could harm you and please take extra COVID-19 related precautions. If you see needles, don't touch them, notify local police if you find any.

Contact Jessica at jessica@healthylamoillevalley.org if you have any questions!

Question Title

* 1. Your Name (optional)

Question Title

* 2. Your Email Address (optional)

Question Title

* 3. Your Green-Up Town

Question Title

* 4. Please list the streets, parks, and other geographic regions you've worked on during Green-Up Day

Question Title

* 5. Number of cigarette butts

Question Title

* 6. Number of vape devices and materials

Question Title

* 7. Number of small alcohol bottles (nips)

Question Title

* 8. Number of alcohol bottles found

Question Title

* 9. Number of alcohol cans

Question Title

* 10. Number of needles you found and where (DO NOT PICK UP!  Please notify law enforcement for best method of disposal)

Question Title

* 11. Was there a specific area that had a lot of substance related items? Please share details. The more specific the better!

Question Title

* 12. During other times in the year, are there locations in your area where you notice substance related items being dumped? Please details. The more specific you can be, the better.

Question Title

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

Question Title

* 14. Upload a picture of what you found! Do not send pictures of anyone underage holding the products. If you want to share more pictures, please email them to jessica@healthylamoillevalley.org.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

T