Volunteer litter picking request form
Contact details
Organiser name
Group name (if applicable)
Contact telephone number
Contact e-mail address
Proposed Location
Date and time of proposed activity
Location of litter pick
Is it council owned or private owned land?
Description of land
Please give as much detail as you can i.e. what
the land is currently used for, any water
features, uneven ground. You can attach a
photo to your e-mail.
Waste collection
Who will be litter picking?
How many people are you expecting?
Children (under 18)
Is there a first aider attending?
What equipment do you need to borrow?
Litter pickers
Yes/No Quantity
Bags for litter
Yes/No Quantity
Rings to hold the bags open
Yes/No Quantity
High viz vests
Quantity adults
Quantity children
Quantity Adults
Quantity Children
Safety check list
I have read and understood the safety
checklist attached to this document.
Please return this completed form by email to litterpick@rochdale.gov.uk a minimum of two
weeks prior to the event.
Find out how we use your personal information at rochdale.gov.uk/privacy
Safety check list
Groups must have at least one adult co-ordinator present at all times during the litter pick.
The co-ordinator is responsible for:
Ensuring this safety check list is followed
Knowing exactly who is taking part and checking numbers. This can be done by keeping a
register of participants.
Briefing the group on any emergency procedures
Collecting and distributing equipment
Carrying out a litter pick
Ensure all appointed adults have a working mobile phone and all participants have the
correct mobile phone numbers.
Make sure you have a safe meeting place to give a briefing, and to start and return to –
especially if the weather deteriorates.
Appoint an adult to act exclusively as safety lookout during clean ups.
Don’t allow unaccompanied young children to take part or attend clean-ups. Members of
youth groups must have parental permission.
Children must be supervised at all times. Don’t allow them to wander freely, alone or out of
Maintain a working group of 6-10 people and ensure the child/adult ratio is no higher than
8:1 for safe supervision.
Volunteers should wear appropriate clothing and footwear. Flip flops and open toed
footwear is not recommended.
Don’t pick up litter with your bare hands; gloves and litter pickers are available from the
Working near to roads
Don’t work near roads with a speed limit of more than 30 mph, on steep banks, near fast
flowing or deep water, derelict buildings or edges with steep drops that could be
considered dangerous.
Don’t work on the road, central reservations, roundabouts or islands. Stay on the
pavement/verge away from live traffic at least 1.5m from the kerb.
When working near roads always face oncoming traffic and work on one side of the
pavement at a time.
Members of the group working near highways must wear high visibility vests.
Don’t work in darkness or bad weather conditions i.e. when the ground is icy or visibility is
Avoid peak traffic periods i.e. rush hour and stay clear of construction or engineering
Do not distract passing traffic or cause nuisance to members of the public.
Health and wellbeing
Ensure group has access to First Aid materials, anti-bacterial wipes or soap and water.
Do not touch or remove syringes or hazardous items such as unidentified canisters or
drums, poisons, broken glass. Report them to us via through our website
www.rochdale.gov.uk or on 0300 303 8884
Do not try to move heavy items.
Always be considerate towards wildlife, keep gates closed and avoid disturbing animals
and birds. Do not remove natural habitats such as logs and stones.
Ensure the rubbish to be collected by the council is stored safely, and does not cause an
Purchasing public liability insurance is strongly recommended. This will provide cover for
your legal liability arising from accidental damage or injury that may occur during the
event, including damage or injury to a member of the public or their property. An
individual organising a clean-up may be covered by their household insurance but you will
need to check your policy.
These safety precautions are for your guidance only, circumstances can differ depending on the
situation. It will be the responsibility of the co-ordinator to ensure all possible safety measures
are taken by the group.
Rochdale Borough Council cannot be held responsible for acts or omissions of the group whilst
they are undertaking their work.
Remember to print off this safety checklist and keep it with you during your activity.