Participant Waiver Form

Before each scheduled activity, this form must be completed, including the signature of each participant. Keep this form for your records. The District Adopt-A-Highway Coordinator may request this form.

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Status Report

Within a week after your pickup day this form should be sent to the GDOT Maintenance Office in Atlanta.

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Because roadways are dangerous places, all volunteers should be mentally alert while picking up litter. Besides using good common sense, all members should be in good physical condition, including sight and hearing. There should be one supervising adult for every three children aged 12 - 15. Alcohol use is prohibited on GDOT right-of-way.

• Safety Procedures slide show
• Plan for Safety
  • Review safety precautions. Prior to each activity, complete the participant waiver form and have each participant sign it. Save it for your records.
  • Assign work teams and leaders before you reach the site. Distribute trash bags beforehand. Estimate the amount of time for your pickup and agree on a meeting place when you’re finished.
  • Carpool to the site to reduce the number of vehicles parked on the side of the road. Be sure to park in a safe spot as far from the road as possible and all on the same side. Be careful not to park in an area that would obstruct motorists’ views, such as on a curve in the road.
  • Bring along an adequate first-aid kit. Identify the nearest hospital and know how to get there in an emergency. At least one person in your group should know CPR techniques.
  • Bring a cell phone.
  • Obtain emergency contacts for each group member and bring their phone numbers with you.
  • Don't overexert yourself. Bring along a supply of drinking water and take breaks.
• Safe Work Habits
  • Wear your orange safety vests at all times.
  • Work only during daylight hours during good weather. During the hot summer months, it’s a good idea to restrict your work to morning hours.
  • Make sure the litter pickup signs are displayed, and close them after pickup is complete.
  • Work only one side of the road at a time.
  • Whenever possible, face oncoming traffic. Stay alert and be prepared to move out of the way in an emergency. Stay with your team.
  • Do not wear headsets. They could prevent you from hearing traffic or other hazards.
  • Do not crush collected trash to make more room in the bag. Broken or jagged objects could cause accidental injuries.
  • Do not pick up syringes or hypodermic needles, animal carcasses, or heavy, large, or hazardous materials. Flag these items and notify Georgia DOT for pickup.
  • Do not “horse around” or do anything to purposely distract drivers.
  • Avoid poison ivy or other noxious weeds.
  • Avoid insects such as fire ants, yellow jackets, wasps, etc. Also, be aware of and avoid animals such as snakes, possums, and raccoons.
  • Stay away from construction sites, mowing activities, open water, bridges, overpasses, or retaining walls that could be dangerous for workers.
• Safety Gear and Clothing
  • High-visibility vests (loaned to you by Georgia DOT)
  • Trash bags (provided by Georgia DOT)
  • Leather thick-soled boots or shoes
  • Light colored clothing, brightly colored hat
  • Long pants and long-sleeved shirt
  • Sunscreen
  • Insect repellent
  • First aid kit
  • Cell phone