CLEanUpClevelandRoadway Cleanup
Saturday, June 4, 2016
Tired of litter along highways? Help us clean them up!
Gordon Park Parking Lot, 801 East 72nd Street, Cleveland, Ohio 44103
Registration – 8:30 a.m.
Kickoff – 9:00 a.m.
Cleanup – 9:30 a.m. – 11:30 a.m.
Safety is our first priority. Volunteers must be 12 years old or older. Children under 18 must have parent’s signed release for their participation. Pre-register your group today!
ROADWAY CLEANUP REGISTRATION FORM
Online Registration Form Available at or
Contact Name:______
Group /Organization:______
Address:______City:______
Zip Code: ______
Contact Phone Number:______
Fax: ______
Email: ______
Please list the number of volunteers participating in the cleanup event:
Adults: ______Children (ages 12-17): ______
Mail to: Keep Ohio Beautiful, P. O. Box 13135 Fairlawn, OH 44334 Fax to: 330-752-2616 Email:
Please bring the completed Release of Liability form with you to the Cleanup Event. Children 12-17 years of age must have a release of liability form signed by a parent/guardian in order to participate.
Help us beautify Cleveland and all of Cuyahoga County. All it takes is a few hours of your time and a little effort. Anyone 12 years of age and older can volunteer.
CLEanUpCleveland Roadway Cleanup
Release of Liability
Please complete this form and review the safety requirements on the opposite side of this page. All CLEanUpCleveland Roadway Cleanup participants must complete this form. On the blank lines, insert the name of your local KOB affiliate.
I understand that CLEanUpCleveland activities may be physically demanding; I affirm that my health is good, and that I am not under a physician’s care for any undisclosed condition that might endanger my health or that of other participants. I recognize the inherent risk of injury or disability in these activities. I fully understand that if injury occurs it must be documented and reported within 24 hours to Keep Ohio Beautiful, Inc. and the Ohio Department of Transportation and Ohio Turnpike Commission.
Keep Ohio Beautiful, Inc., its Board of Directors, its staff members, the Ohio Department of Transportation and Ohio Turnpike Commission, are also released from all liability for any injury to me from participation in the CLEanUpCleveland Roadway Cleanup. Keep Ohio Beautiful, Inc., the Ohio Department of Transportation and Ohio Turnpike Commission are further given the free use of my likeness in the connection with any broadcast, release, media account or other publicity generated by the activity.
______
Printed Name
______
SignatureDate
______
Signature of parent or guardian if under 18 years of ageDate
Safety First!
Clothing Recommendations:
- All participants should wear brightly colored clothing.
- Wear hard-soled shoes with no open toes.
- Wear longs pants.
- Use gloves when handling litter, rubber gloves when handling contaminated items.
- Traffic vests should be worn if working along highways.
Team Make-up and Use Considerations
- Young persons should be 16 or older to work along expressways, exit or entrance ramps and railroad right of ways.
- Children under 16 should have the supervision of at least one adult for every five
children.
- Youths 16 or older should always work in groups of at least two, especially near
waterways.
- Consider physical limitations when assigning work areas, those with limited mobility should be utilized on level, smooth surfaces.
- Account for all volunteers before closing up shop in an area--no one left behind.
Safe Working Tips
- All normal safe working precautions should apply.
- Never pick up weapons or drugs. Contact the Police Department.
- If a situation looks suspicious or threatening, leave the area and contact the Police.
- Do not use electrical equipment around water.
- Wear eye protection when operating machinery or equipment.
- Don’t over-extend when lifting or reaching.
- Turn over things, including tires, before lifting.
- Hazardous materials, including IV needles or syringes, require and adult with rubber gloves and a shovel or a qualified person to handle and dispose of the object. It’s best to place them in a glass container or a bucket--NOT in trash bags.
- Chemicals other than household items should be reported to the proper authorities.
- Use rubber gloves when handling any chemicals.
- An adult should be in charge of transportation and pedestrian traffic at the works site.
- If lightning is in the area, seek safety inside a building or vehicle.
Finally, we thank you and ask you to please work safely!