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Feedback Form
Area Details
Form to fill out Area details
Area Number
Area name
Observer's Name
Month Ending
1. Footpaths
Form to fill out about Footpaths
What is the condition of the shoreline footpath?
Please Select
Good
Fair
Poor
What is the condition compared to last month?
Please Select
Better
Same
Worse
Has any damage occurred to signposts/stiles etc.
YES
NO
If yes, please give details.
2. Sea Defences
Form to fill out about Sea Defences
What is the condition of the sea defences?
Please Select
Good
Fair
Poor
What is the condition compared to last month?
Please Select
Better
Same
Worse
Please give details.
3. Water Pollution
Form to fill out about Water Pollution
Have you seen any water pollution in your section?
YES
NO
If so was it :
Please Select
Oil Based
Agricultural
Sewage
Industrial
Other
If yes, please give details.
Was it reported?
YES
NO
If so, to whom?
Was it cleared up?
YES
NO
Did you see any lumps of tar?
YES
NO
Did you see any dead birds/animals?
YES
NO
If Yes, please give details
4. Dumping and Dredging
Form to fill out about Dumping and Dredging
Has any dumping occurred in the last month?
YES
NO
If so, please give details of where, when, whom, etc.
Was any of it garden rubbish or old crops?
YES
NO
Was any of it refuse in bags?
YES
NO
Was any of it fish or shellfish waste?
YES
NO
5. Litter
Form to fill out about Litter
Please State how much litter you saw
Please Select
Slight (no more than one item in 20 yards)
Moderate (about five items in 20 yards)
Bad (at least 10 Items in 20 yards)
Appalling (almost continuous)
If it is variable, please indicate how much of the section falls into each category?
Has any clearance been done in the last month?
Please Select
Yes
No
Don't Know
If so, by whom?
Please Select
Residents
Others
Don't Know
If it was by you (thank you!) how many bags did you fill?
If you can, please complete whether you collected it or not
Number of Large Items (too big to fit in a bin bag) - please check Yes, or complete a number if you can.
Oil Drums
Crates (Bread/Fish etc.)
Furniture
Bits of Machinery
Boats (or parts of)
Large Plastic
Other - please describe
Number of Small Items - please check Yes, or complete a number if you can.
Syringes
Other Medical Waste
Nappies
Potentially dangerous canisters
(Please report these ASAP)
Paper/Cardboard
Fishing Gear/Rope
Packing Straps
Polystyrene
Plastic Drinks Bottles
Other Plastic Containers
Other Plastic
Small Metal
(
Cans,Aerosols etc.
)
Unwrapped Food
Four/Six Pack Holders
Sanitary Materials
Glass
Clothes/Shoes/Rags
Dog Muck
Any other comments?
6. Baitdigging
Form to fill out about Baitdigging
How many bait diggers did you see?
7. Wildlife
Form to fill out about Wildlife
Has there been any damage to habitats?
YES
NO
If yes, please provide details:
Please add any other wildlife information / observations:
Feedback Submission
Form to fill out for Feedback Submission
Please enter the text you see displayed in the image:
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