Tennessee Department of Transportation
John Schroer, Commissioner

Environmental Division - Beautification Office

Adopt-A-Highway Program
James K. Polk Building, Suite 400
505 Deaderick Street
Nashville, Tennessee 37243-0333
Phone: 615.741.6896
Fax: 615.532.5995

On-line Volunteer Activity Report Form
(Please complete after each pickup)

Thank you for cleaning up your adopted stretch of Tennessee roadway! Your contribution to the environment is important to us, and allows us to record and track your activities and accomplishments. Please submit a separate report for each pickup date.

Date of Pickup Event:

Name of Volunteer Group:

Name of Group's Contact Person/Coordinator:

Street Address:

City:

State:

Zip:

Telephone:

E-mail Address:

Adopted Route:

County where adopted roadway is located:

Total number of volunteers whom participated in this pickup event:

Total number of hours your groups spent on this activity:

Total number of bags collected:

How many bags of recyclables did your group collect, if applicable? (NOTE: Volunteer groups are permitted to separately bag recyclable items and turn in to a redemption center for fundraising cash.)

Bag Disposal Method: How will you dispose of your bags?
Please have TDOT crews pick up the bags from the side of our adopted roadway section. (NOTE: If you leave bags on the side of the road for TDOT crews to pick up, please also contact your District Coordinator to make sure the road crew is dispatched as quickly as possible.)
Our volunteer group properly disposed of the bags ourselves.

Any unusual items found?

Any interesting stories about your volunteers or pickup event you would like
to share?

Additional Comments: