Community Waterbody Cleanliness Survey Form
Share your feedback to help us improve the cleanliness of our local waterbody. Your responses will help guide future community initiatives.
How often do you visit the local waterbody?
*
Please Select
Daily
Weekly
Monthly
Rarely
Never
How would you rate the overall cleanliness of the waterbody?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The water appears clear and free of debris.
1
2
3
4
5
There is minimal litter around the waterbody.
6
7
8
9
10
The area smells clean and fresh.
11
12
13
14
15
I feel safe spending time near the waterbody.
16
17
18
19
20
What types of pollution or issues have you observed at the waterbody? (Select all that apply)
Litter (plastic, cans, bottles)
Algae or unusual water color
Unpleasant odor
Oil or chemical sheen
Dead fish or wildlife
None observed
Other
How satisfied are you with the current efforts to keep the waterbody clean?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
Would you be interested in participating in future clean-up events?
Yes
No
Maybe
Please share any suggestions or comments about improving waterbody cleanliness.
Submit Survey
Should be Empty: