Y-Valve Education Pilot Program Tracking Form

Data Collection Form

The Y-Valve Education Program is a pilot so it is essential that we track results to evaluate the challenges and effectiveness of the pilot. To do this, we need your help! We’ve tried to make this process as simple and painless as possible for you.

During this pilot, we hope to learn from you what works and what doesn’t work. We’ve created a simplified tracking process to make it easy for your marina or yacht club to provide us with information about the pilot.

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* 1. Contact information

Name of Marina or Yacht Club

Name of contact

Email Address

Phone Number

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* 2. When did you conduct the Y-valve check? Please select the date. If you have multiple dates, please fill this form for each individual dates

Date of inspection

Date

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* 3. How many Liveaboard boats did you inspected?

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* 4. How many seasonal moorage did you inspect?

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* 5. How many full time moorage boats did you inspect?

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* 6. How many Y-valves were found opened during inspection?

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* 7. Did you use dye tab during inspection?

Yes

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* 8. Was dye tab visible in the water during the inspection?

Yes

How many boats had discharges?

Y-Valve Education Pilot Program Tracking Form

Data Collection Form

Question Title

* 1. Contact information

Question Title

* 2. When did you conduct the Y-valve check? Please select the date. If you have multiple dates, please fill this form for each individual dates

Question Title

* 3. How many Liveaboard boats did you inspected?

Question Title

* 4. How many seasonal moorage did you inspect?

Question Title

* 5. How many full time moorage boats did you inspect?

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* 6. How many Y-valves were found opened during inspection?

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* 7. Did you use dye tab during inspection?

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* 8. Was dye tab visible in the water during the inspection?

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* 9. Do you have any other comments or thoughts about the Pilot?