Adopt-A-Highway Summary Report
Answers marked with a * are required.
 
1. Which cleanup event are you reporting? *

      

 
 
 
2. Please supply your information *
Group Name
Date Worked
Contact Person
Phone
Street Address
 
 
 
3. We need your location and participant information *
City
State
Zip Code
# of Participants
Hours Each Person Worked
 
 
 
4. What is your average age group?
 
 
 
5. If you know this information great!
County
Route
Beginning Post Mile
Ending Post Mile
 
 
 
6. This information is critical! *
Trash Collected (Bags)
Recyclables Collected (Bags)
Vegetation Controlled (Acreage)
Number of New Tree Plantings
Grafitti Removed (Sq Ft)
 
 
 
7. Have you ever kept recyclables found? We encourage recycling! *
 
 
 
8. If you keep recyclables, on average how many bags do you keep during monthly cleanup events?
 
 
 
9. Did you keep any bags of recyclables during this event? *
How many bags of recyclables did you keep during this event?
 
 
 
10. Did you provide advance notice of your plans to work to your Caltrans representative? *
 
 
 
11. It's interesting to read about items you collect, please also provide feedback for improvement!
Most unusual items collected
Suggestions or comments
 
 
 
 
 

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