The E-Waste Survey Form.pdf
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E-waste Profilng Survey 1 of 2 Date: / / 2011 Surveyors name: Form no. (dd) (mm) Type (circle one): Household / Business / Government Location: e.g. Anse Royale If household, estimate yearly income (circle one): If Government/business please state name: What kind of electronic products do you have (in use or in storage)? 103 LHHA Kitchen, furnaces, ovens No. Description No. Condition (circle) 102 Dishwashers 1031 Combi-ovens usable unusable Description No. dition (circle) 1032 Furnaces usable unusable 2051 Person weighing scale usable unusable 1033 Ovens usable unusable 2052 Hair dryers usable unusable 2053 Shavers usable unusable No. 2053 Shavers and trimmers usable unusable 1041 Washing machines 106 LHHA HH Room heating and ventilation 2054 Other hairstyling usable unusable 1042 Washing machines + combi-dryers Description No. Condition (circle) 2055 Other massage usable unusable 1061 Hoods usable unusable 2056 Toothbrushes usable unusable 1062 HH room ventilation (fixed) usable unusable 2057 Solaria, IR lamps usable unusable 1063 Room heaters (non central) usable unusable 2058 Other personal care usable unusable No. 1051 Dryers 1052 Centrifuges 201 SHA Clothing, Ventilation, Time, other Description No. Condition (circle) Description No. dition (circle) 2011 Irons usable unusable 3011 Mouses usable unusable 2012 Sewing usable unusable 3012 Keyboards usable unusable No. 2013 Other Clothing usable unusable 3013 External optical drives usable unusable 1081 Fridges (excl. combi freezers) 2014 Ventilators (small moveable) usable unusable 3014 External storage (drives) usable unusable 1082 Wine fridge 2015 Other ventilation small, insect removal usable unusable 3015 External storage (flash) usable unusable 1083 Absorption fridge 2015 Other ventilation small, odours usable unusable 3016 Computer accessoires (speakers, mo usable unusable 2016 Sleeping usable unusable 3017 External power supply and adapters usable unusable 2017 Clocks usable unusable 3018 (Pocket) calculators usable unusable 2018 Other SHA usable unusable 3019 Other small IT usable unusable No. 1091 Freezers 202 SHA Food Description No. Condition (circle) Description No. dition (circle) 2021 Cooking plates (excl. oven) usable unusable 3021 Desktop personal computers usable unusable No. 2022 Frying pans usable unusable 1101 Combi fridges and freezers 2023 Warming food (BBQ, toasters, etc) usable unusable 2024 Grills usable unusable 2025 Blending and mixing usable unusable Description No. dition (circle) 2026 Other kitchen equip, incl elec. coolers usable unusable 3031 Laptops usable unusable No. 3032 Tablets 1111 HH airconditioning (moveable, ex split sys) 3033 Notebooks 1112 HH airconditioning (fixed, split sys) 3034 Other laptops, palmtops 1113 Other airconditioning and dehumidifying No. 2041 HH Vacuum cleaners 2042 Other vacuum and carpet cleaners No. No. 3051 Cordless phones 1141 Combi-microwave 3052 Telephones (fixed) 1142 Microwave (non-combi) 3053 Other HH telecom usable unusable unusable usable 109 C&F Freezers unusable usable unusable usable unusable 110 C&F Combi-fridges and freezers Description Condition (circle) Description Condition (circle) usable unusable Description Condition (circle) 305 IT Telecom usable unusable usable unusable usable unusable usable unusable Description Condition (circle) usable unusable usable unusable 114 SLHA Microwaves usable unusable usable unusable usable unusable usable 204 SHA Vacuum cleaners unusable Description Condition (circle) Number of people in the household / organization below 50,000 50,000 to 100,000 above 100,000 usable 102 LHHA Dishwashing Description Condition (circle) Description Condition (circle) usable unusable 105 LHHA Wash dryers and centrifuges Condition (circle) usable unusable usable unusable 205 SHA Personal Care 301 IT Small IT and accessoires 302 IT Desktop PC's Condition (circle) Description unusable usable Description 104 LHHA Washing machines usable unusable 303 IT Laptop PC's 108 C&F Fridges Description Condition (circle) usable unusable usable unusable 111 C&F Airconditioning
description
E Waste Survey
Transcript of The E-Waste Survey Form.pdf
E-waste Profilng Survey 1 of 2
Date: / / 2011 Surveyors name: Form no.(dd) (mm)
Type (circle one): Household / Business / Government
Location:e.g. Anse Royale
If household, estimate yearly income (circle one): If Government/business please state name:
What kind of electronic products do you have (in use or in storage)?
103 LHHA Kitchen, furnaces, ovens
No. Description No. Condition (circle)
102 Dishwashers 1031 Combi-ovens usable unusable Description No.Condition (circle)
1032 Furnaces usable unusable 2051 Person weighing scale usable unusable
1033 Ovens usable unusable 2052 Hair dryers usable unusable
2053 Shavers usable unusable
No. 2053 Shavers and trimmers usable unusable
1041 Washing machines 106 LHHA HH Room heating and ventilation 2054 Other hairstyling usable unusable
1042 Washing machines + combi-dryers Description No. Condition (circle) 2055 Other massage usable unusable
1061 Hoods usable unusable 2056 Toothbrushes usable unusable
1062 HH room ventilation (fixed) usable unusable 2057 Solaria, IR lamps usable unusable
1063 Room heaters (non central) usable unusable 2058 Other personal care usable unusable
No.
1051 Dryers
1052 Centrifuges 201 SHA Clothing, Ventilation, Time, other
Description No. Condition (circle) Description No.Condition (circle)
2011 Irons usable unusable 3011 Mouses usable unusable
2012 Sewing usable unusable 3012 Keyboards usable unusable
No. 2013 Other Clothing usable unusable 3013 External optical drives usable unusable
1081 Fridges (excl. combi freezers) 2014 Ventilators (small moveable) usable unusable 3014 External storage (drives) usable unusable
1082 Wine fridge 2015 Other ventilation small, insect removal usable unusable 3015 External storage (flash) usable unusable
1083 Absorption fridge 2015 Other ventilation small, odours usable unusable 3016 Computer accessoires (speakers, modems,etc.)usable unusable
2016 Sleeping usable unusable 3017 External power supply and adapters IT usable unusable
2017 Clocks usable unusable 3018 (Pocket) calculators usable unusable
2018 Other SHA usable unusable 3019 Other small IT usable unusable
No.
1091 Freezers
202 SHA Food
Description No. Condition (circle) Description No.Condition (circle)
2021 Cooking plates (excl. oven) usable unusable 3021 Desktop personal computers usable unusable
No. 2022 Frying pans usable unusable
1101 Combi fridges and freezers 2023 Warming food (BBQ, toasters, etc) usable unusable
2024 Grills usable unusable2025 Blending and mixing usable unusable Description No.Condition (circle)
2026 Other kitchen equip, incl elec. coolers usable unusable 3031 Laptops usable unusable
No. 3032 Tablets
1111 HH airconditioning (moveable, ex split sys) 3033 Notebooks
1112 HH airconditioning (fixed, split sys) 3034 Other laptops, palmtops
1113 Other airconditioning and dehumidifying No.
2041 HH Vacuum cleaners
2042 Other vacuum and carpet cleaners
No.
No. 3051 Cordless phones
1141 Combi-microwave 3052 Telephones (fixed)
1142 Microwave (non-combi) 3053 Other HH telecom usable unusable
unusable
usable
109 C&F Freezers
unusable
usable unusable
usable unusable
110 C&F Combi-fridges and freezers
Description Condition (circle)
Description Condition (circle)
usable unusable
Description Condition (circle)
305 IT Telecomusable unusable
usable unusable
usable unusable
usable unusable
Description Condition (circle)
usable unusable
usable unusable
114 SLHA Microwaves
usable unusable
usable unusable
usable unusable
usable 204 SHA Vacuum cleanersunusable
Description Condition (circle)
Number of people in the household / organization
below
50,000
50,000 to
100,000
above
100,000
usable
102 LHHA Dishwashing
Description Condition (circle)
Description Condition (circle)
usable unusable
105 LHHA Wash dryers and centrifuges
Condition (circle)
usable unusable
usable unusable
205 SHA Personal Care
301 IT Small IT and accessoires
302 IT Desktop PC's
Condition (circle)Description
unusableusable
Description
104 LHHA Washing machines
usable unusable
303 IT Laptop PC's
108 C&F Fridges
Description Condition (circle)
usable unusable
usable unusable
111 C&F Airconditioning
No. Description No. Condition (circle) Description No. Condition (circle)
3041 HH Multifunctionals (fax, print, scan, copy, etc.) 4021 mp3 and mp4 players usable unusable 5021 CFL lamps (integrated, HH) usable unusable
3042 Inkjet printers 4022 radio and CD (portable) usable unusable 5022 CFL lamps (non-integrated, PROF) usable unusable
3043 Laserprinters 4023 radio alarm clock with CD usable unusable
3044 Other printers (matrix, thermal) 4024 speakers (portable) usable unusable
3045 Scanners 4025 Navigation systems (portable) usable unusable
3046 Typewriters 4026 E-readers usable unusable Description No.Condition (circle)
3047 Faxes 4027 Other portable audio usable unusable 5031 Straight fluorescent HH usable unusable
5032 Straight fluorescent B2C usable unusable
No. Description No. Condition (circle)
3061 Mobile phones 4031 Receivers and amplifiers usable unusable Description No. Condition (circle)
3062 Smartphones 4032 Mini-midi and micro sets usable unusable 5041 High pressure sodium usable unusable
3063 Other mobile phone devices (pagers) 4033 Car stereo usable unusable 5042 Low pressure sodium usable unusable
4034 Other audio components usable unusable 5043 Metal halide lamps usable unusable
4035 Music, sound mixing boards usable unusable 5044 High pressure mercury usable unusable
No.
3071 PROF Multifunctionals (fax, print, scan, copy, etc.)
3072 Copiers Description No. Condition (circle) Description No. Condition (circle)
3073 Plotters and blueprinting 4041 DVD players and recorders usable unusable 5051 Retrofit LED lamps usable unusable
3074 Servers and workstations 4042 Blue-ray players and recorders usable unusable 5052 LED inc. luminaire HH usable unusable
3075 Overhead projectors and beamers 4043 VCR players and recorders usable unusable
3076 Other PROF and network equipment 4044 Decoders and satellite receivers usable unusable
4045 Video and antenna equipment usable unusable
No.
5071 PROF Luminaires
Description No. Condition (circle) 5072 PROF LED Luminaires
3081 CRT Monitors usable unusable Description No. Condition (circle)
4061 Digital Still Camera (photo) usable unusable
4062 Video Camera (incl. photo function) usable unusable
No.
Description No. Condition (circle) 7011 Small toys
3091 LCD Monitors usable unusable 7012 Vehicle toys
3092 LED Monitors usable unusable Description No. Condition (circle) 7013 Small music toys
3093 Small flat screens usable unusable 4071 CRT TV's (incl. combi DVD, VCR) usable unusable
No.
Description No. Condition (circle) Description No. Condition (circle) 7021 Game consoles (TV, Monitor connected)
4011 Headphones and headsets usable unusable 4081 LCD TV's usable unusable 7022 Game consoles (portable)
4012 Microphones usable unusable 4082 LED TV's usable unusable 7023 Games consoles accessoires
4013 Adapters and power supply CE usable unusable 4083 Plasma TV's usable unusable 7024 Games (cards)
4014 Remote controls usable unusable
4015 Other small CE usable unusable
403 SHA Radio and Hifi
401 SHA Small CE and accessoires
309 IT Flat panel monitors
308 IT CRT Monitors
usable unusable
usable unusable
usable unusable
usable unusable
702 IT Video Gaming
Description Condition (circle)
usable unusable
701 SHA Small Toys
Description Condition (circle)
usable unusable
usable unusable
507 PROF Luminaires
Description Condition (circle)
usable unusable
usable unusable
unusable
usable unusable
usable unusable
usable unusable
307 PROF IT
Description Condition (circle)
usable unusable
usable unusable
usable
usable unusable
usable unusable
usable unusable
306 IT Mobile phones
404 SHA Video 505 LAMPS LED
402 SHA Portable audio and video 502 LAMPS CFL
406 SHA Cameras
407 CRT TV's
408 Flat Display Panel TV's
Description Condition (circle)
usable unusable
usable unusable
usable unusable
304 IT Printing and imaging
Description Condition (circle)
usable unusable
503 LAMPS TL
504 LAMPS PROF Special
usable unusable
usable unusable
usable unusable
