Tobacco Litter at Beaches Observation Form

COLLECTION OF TOBACCO BUTT LITTER AT BEACHES Data Collection Form Collection Date: ____/____/____ Location: □ Amphitheater

Day of the week: □ Monday □ Saturday □ Sunday

□ Tuesday □ Wednesday □ Thursday □ Friday

□ Pier □ North of Pier □ South of Pier □ Another Beach: ____________________

Collector(s): ______________________________________________________________________________________

This form records the amount of tobacco butt litter in selected Oceanside beach areas. Carefully record collection time and collection area. This will enable us to make comparisons from site to site, or of the same site at different times. A detailed checklist is provided below to be completed for each collection site. Select a stretch of coastline at least 150 feet long. Collect and record the tobacco butt litter found there using the bags provided. For the first bag of butts collected note the number of butts a bag can hold. Continue collecting butts using the remaining bags. In the boxes below please record: the collection time period, the number of cigarette butts you collect (number of butts per bag, number of bags, total number of butts), and additional information. To aid in relocating collection sites please sketch a rough map of the collection area on the back of the form. Location Summary Defined Boundaries

Litter Summary

Length (feet): _________ Width (feet):_________

Number of bags: ______________

Estimated area survey site (sq. ft.): ____________

Number of butts per bag: _______

Collection Start Time

_____________________________

□ AM □ PM

Collection End Time

_____________________________

□ AM □ PM

Seasonal period:

□ Off season □ Tourist season □ Public holiday

Tide conditions:

□ Low tide □ High tide

Evidence of recent litter pick-up?

□ Yes □ No

Last beach clean-up date(s): ________________________________________ Last beach clean-up sponsoring organization(s): ________________________ Observed acts of littering while collecting?

□ Yes □ No

Total number of butts: _________ Was there a specific area in the observation site where tobacco litter is especially concentrated or high? (i.e. near garbage cans, drinking fountains, benches, etc.) □ Yes: ________________________ □ No Photograph of this location obtained? □ Yes □ No

General Observations

Note: To aid in relocating collection sites please sketch a rough map of the collection area on the back of the form. Vista Community Clinic

Healthy Environments Against Tobacco

(H.E.A.T.)

This document was made possible by funds received from the California Department of Health Services, Tobacco Control Section, under Contract No. 05-45736.

California Smoker’s Helpline – 1-800-NO-BUTTS

or

1-800-45-NO-FUME