Environmental Conservation Checklist Form
Please complete the checklist to help us assess your environmental conservation efforts.
Do you recycle regularly?
Yes
No
Sometimes
Do you use energy-efficient appliances?
Yes
No
Planning to
Do you use renewable energy sources?
Yes
No
Considering
Do you practice water conservation?
Yes
No
Sometimes
Do you participate in local environmental activities?
Yes
No
Occasionally
Additional Comments
Submit
Should be Empty: