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* 1. What is your group or individual name?

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* 2. If you are a group, how many people are active in the group?

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* 3. What is the best group/individual phone number for site contact?

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* 4. What is your adopted road/site?

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* 5. What is the date of your last clean-up activity?

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* 6. Would you like to continue involvement in the program?

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* 7. How did you learn about the Road Watch- Adopt A Road program?

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* 8. How long have you been actively involved in the program?

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* 9. How do you currently get to your site?

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* 10. How many clean-up activities per year are you completing on average?

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* 11. How many clean-up activities per year would you LIKE to complete on average

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* 12. How do you currently report your findings?

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* 13. How would you LIKE to report your findings?

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* 14. How do you currently dispose of collected materials?

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* 15. How would you LIKE to dispose of collected materials?

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* 16. Do you currently use equipment provided by KESAB?

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* 17. Is there additional/alternative equipment that you would find useful for clean-up activities?

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* 18. Have you refreshed your safety knowledge lately or since the impacts of COVID-19?

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* 19. Do you/ a member of your group have a current first aid certificate?

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* 20. Would you like KESAB to facilitate more people to join your group?

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* 21. Have you noticed any trends/ changes in the littered materials collected? (e.g. quantities, common items etc)

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* 22. Please let us know if there are other ways that we can support you and improve the program.

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* 23. Please add any further comments

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