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Neighborhood Development Feedback Form

 

 
Contract Number
 
Name of City Street
 
Date of Cleanup
 
Number of Cleanup Participants
 
Work Hours per Person
 
Number of Trash Bags
 
Did you use trash bags provided from the City and obtained from a Code Enforcement Office?
Yes
No
 

Did you use orange safety vests for your cleanup?
Yes
No
If so, did you obtain the vests from a Code Enforcement Office?
Yes
No
If so, did you return the vests?
Yes
No
 

Did you call Special Services to pickup the bags of trash from the cleanup?
Yes
No
 

Did you experience any problems during the Cleanup?
Yes
No
If so, please explain:
 

Do you have any additional comments or information?
 


Group Name
 
Name of Volunteer
 
Address
 
Phone
 
Email
 

Thank you for completing the Adopt-A-City Street Program Cleanup Report. You can report a Cleanup online at http://kcb.charmeck.org. Scroll down and hit the submit button to complete the survey.
 
City of Charlotte