Enter your own results

Please use the form below to enter your clean-up results, providing as much information as possible. Once you have finished click submit at the bottom of the page and you will receive your results summarised in graph format. Send in your survey sheet to the Sir Peter Blake Trust to have your results validated and included as part of the nationwide clean-ups!

* Required field

1. Co-ordinator's name*:
2. School or group name*:
3. Contact address of group:
4. Contact phone:
5. Contact email address:
6. Number of children*:
7. Number of adults*:
8. Number of Westpac staff (from total number of adults):
9. Number of Fuji Staff (from total number of adults):
10. Cleanup date (dd-mm-yyyy)*:
11. Time start (hh:mm) (24-hour clock)*:
12. Time finish (hh:mm) (24-hour clock)*:
13. Clean up region*: Select… Northland Auckland Waikato Bay of Plenty Gisborne Hawkes Bay Manawatu-Wanganui Taranaki Wellington Marlborough Nelson Tasman West Coast Canterbury Otago Southland
14. Name of cleanup area:
15. Length of cleanup area (m)*:
16. Width of cleanup area (m)*:
17. General direction cleanup area is facing: Select… North South East West
18. Description of cleanup area:
19. Cleanup method: Select… Sweep Grids and Quadrats Transect line Strand line Other
20. Description of other cleanup method:
21. Please indicate whether there have been any heavy rains: Select… Yes No
22. Please indicate whether there have been any heavy winds: Select… Yes No
23. If there have been recent heavy winds, please indicate general direction by choosing from the list below: Select… Onshore Offshore Cross-shore
24. Please note any other factors that you think might have affected the amount or type of rubbish in your cleanup area:

25. 1. Glass

26. Bottles:
27. Other - e.g. light bulbs:
28. Fragments (please estimate):

29. 2. Aluminium, Steel, Tin

30. Cans:
31. Bottle tops / caps:
32. Other - e.g. foil, drums:

33. 3. Paper, Board, Timber

34. Paper cups, plates, bowls:
35. Cardboard cartons:
36. Paper bags:
37. Paper sheets:
38. Timber (not driftwood):
39. Other - e.g. iceblock sticks:

40. 4. Textiles and Fabric

41. Shoes:
42. Clothing items:
43. Pieces of textile, fabric, towel:

44. 5. Medical and Personal

45. Disposable nappies:
46. Syringes:
47. Sanitary items:
48. Condoms:
49. Other - e.g. plasters, bandages:

50. 6. Rubber

51. Rubber items - e.g. balloons, tyres, jandals:

52. 7. Foam

53. Foam items - e.g. cups, packaging, insulation:

54. 8. Hard Plastic

55. Bottles:
56. Drinking straws:
57. Eating utensils:
58. Packaging bands:
59. Cartons / buckets:
60. Plastic bottle tops:
61. Lollypop sticks:
62. Other - e.g. toys, pens:
63. Fragments (please estimate):

64. 9. Plastic Sheet and Fibre

65. Plastic bags:
66. Food wrappers:
67. Cigarette butts:
68. Other - e.g. mesh:
69. Fragments (please estimate):

70. 10. Fishing Gear

71. Netting:
72. Fishing line:
73. Twine:
74. Hooks and other tackle:
75. Pots or traps:
76. Bait goods - e.g. bags, strapping:
77. Buoys or floats:
78. Other:

79. 11. Rope and Cord

80. Rope and cord (Non-fishing):

81. 12. Other

82. Other items (not listed above):
83. Description, number and source of 'other' items:

84. 13. Comments

85. Please tell us about your clean-up: