River Conservation Survey Form
Share observations about river usage, river conditions, conservation concerns, and suggested actions for protecting local waterways.
Respondent Information
Respondent Name
*
Email Address
*
example@example.com
General Location / River Area Observed
*
River Use and Observation Details
How often do you visit or use the river?
*
Daily
Weekly
Monthly
A few times a year
Rarely
First time
Other
Primary purpose of river use
*
Recreation
Fishing
Boating
Swimming
Wildlife observation
Photography
Research
Work-related
Other
Date of observation or visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
River Condition Survey
Overall River Condition Rating
*
1
2
3
4
5
Key River Condition Assessment
*
Rows
Poor
Fair
Good
Excellent
Water clarity
1
2
3
4
Visible litter
5
6
7
8
Odor
9
10
11
12
Bank erosion
13
14
15
16
Wildlife presence
17
18
19
20
Conservation Concerns and Actions
Observed Pollution Sources or Environmental Concerns
*
Plastic litter
Sewage or wastewater discharge
Agricultural runoff
Industrial discharge
Oil or fuel sheen
Erosion or sediment buildup
Invasive plant species
Habitat disturbance
Illegal dumping
Algal bloom
Low water flow
Wildlife disturbance
Other
Suggested Conservation Actions or Support Needed
Submit
Should be Empty: