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E-waste Profilng Survey

Date:
(dd)

1 of 2

/
(mm)

/ 2011

Surveyors name:

Form no.

Type (circle one): Location:


e.g. Anse Royale

Household / Business / Government Number of people in the household / organization


below 50,000 50,000 to 100,000 above 100,000

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)? 102 LHHA Dishwashing No. 103 LHHA Kitchen, furnaces, ovens Description No. Condition (circle) 1031 Combi-ovens usable unusable 1032 Furnaces usable unusable 1033 Ovens usable unusable

Description 102 Dishwashers

Condition (circle) usable unusable

Description
2051 Person weighing scale 2052 Hair dryers 2053 Shavers 2053 Shavers and trimmers

Description
1041 Washing machines

104 LHHA Washing machines No.

1042 Washing machines + combi-dryers

Condition (circle) usable unusable usable unusable

105 LHHA Wash dryers and centrifuges Description No. Condition (circle) 1051 Dryers usable unusable 1052 Centrifuges usable unusable

106 LHHA HH Room heating and ventilation Description No. Condition (circle) 1061 Hoods usable unusable 1062 HH room ventilation (fixed) usable unusable 1063 Room heaters (non central) usable unusable

2054 Other hairstyling 2055 Other massage 2056 Toothbrushes 2057 Solaria, IR lamps 2058 Other personal care

205 SHA Personal Care Condition (circle) No. usable usable usable usable usable usable usable usable usable

unusable unusable unusable unusable unusable unusable unusable unusable unusable

108 C&F Fridges Description No. 1081 Fridges (excl. combi freezers) 1082 Wine fridge 1083 Absorption fridge

Condition (circle) usable unusable usable unusable usable unusable

Description
1091 Freezers

109 C&F Freezers No.

201 SHA Clothing, Ventilation, Time, other Description No. Condition (circle) 2011 Irons usable unusable 2012 Sewing usable unusable 2013 Other Clothing usable unusable 2014 Ventilators (small moveable) usable unusable 2015 Other ventilation small, insect removal usable unusable 2015 Other ventilation small, odours usable unusable 2016 Sleeping usable unusable 2017 Clocks usable unusable 2018 Other SHA usable unusable

Description
3011 Mouses 3012 Keyboards

301 IT Small IT and accessoires Condition (circle) No.


usable usable usable usable unusable unusable unusable unusable unusable unusable unusable unusable unusable

3013 External optical drives 3014 External storage (drives)

3015 External storage (flash) usable 3016 Computer accessoires (speakers, modems,etc.) usable 3017 External power supply and adapters IT usable 3018 (Pocket) calculators usable 3019 Other small IT usable

Condition (circle) usable unusable No. Condition (circle) 2021 Cooking plates (excl. oven) usable unusable 2022 Frying pans usable unusable 2023 Warming food (BBQ, toasters, etc) usable unusable 2024 Grills usable unusable 2025 Blending and mixing usable unusable 2026 Other kitchen equip, incl elec. coolers usable unusable 202 SHA Food Description Description 302 IT Desktop PC's Condition (circle) No. 3021 Desktop personal computers usable

110 C&F Combi-fridges and freezers Description No. Condition (circle) 1101 Combi fridges and freezers usable unusable

unusable

Description
3031 Laptops 3032 Tablets 3033 Notebooks

Description

111 C&F Airconditioning No.

1111 HH airconditioning (moveable, ex split sys) 1112 HH airconditioning (fixed, split sys) 1113 Other airconditioning and dehumidifying

Condition (circle) usable unusable usable unusable usable unusable

204 SHA Vacuum cleaners Description No. Condition (circle) 2041 HH Vacuum cleaners usable unusable 2042 Other vacuum and carpet cleaners usable unusable

3034 Other laptops, palmtops

303 IT Laptop PC's Condition (circle) No. usable unusable usable unusable usable unusable usable unusable

Description
1141 Combi-microwave 1142 Microwave (non-combi)

114 SLHA Microwaves No.

Description Condition (circle) usable unusable usable unusable


3051 Cordless phones 3052 Telephones (fixed) 3053 Other HH telecom

305 IT Telecom No. Condition (circle) usable unusable usable unusable usable unusable

Description
3042 Inkjet printers 3043 Laserprinters

304 IT Printing and imaging No.

3041 HH Multifunctionals (fax, print, scan, copy, etc.)

3044 Other printers (matrix, thermal) 3045 Scanners 3046 Typewriters 3047 Faxes

Condition (circle) usable unusable usable unusable usable unusable usable unusable usable unusable usable unusable usable unusable

402 SHA Portable audio and video No. Condition (circle) 4021 mp3 and mp4 players usable unusable 4022 radio and CD (portable) usable unusable 4023 radio alarm clock with CD usable unusable 4024 speakers (portable) usable unusable 4025 Navigation systems (portable) usable unusable 4026 E-readers usable unusable 4027 Other portable audio usable unusable Description

502 LAMPS CFL No. Condition (circle) 5021 CFL lamps (integrated, HH) usable unusable 5022 CFL lamps (non-integrated, PROF) usable unusable Description

Description
5031 Straight fluorescent HH 5032 Straight fluorescent B2C

503 LAMPS TL Condition (circle) No. usable usable

unusable unusable

Description
3061 Mobile phones 3062 Smartphones

306 IT Mobile phones No.

3063 Other mobile phone devices (pagers)

Condition (circle) usable unusable usable unusable usable unusable

403 SHA Radio and Hifi No. Condition (circle) 4031 Receivers and amplifiers usable unusable 4032 Mini-midi and micro sets usable unusable 4033 Car stereo usable unusable 4034 Other audio components usable unusable 4035 Music, sound mixing boards usable unusable Description

Description
5041 High pressure sodium 5042 Low pressure sodium 5043 Metal halide lamps 5044 High pressure mercury

504 LAMPS PROF Special No. Condition (circle) usable unusable usable unusable usable unusable usable unusable

Description
3072 Copiers 3073 Plotters and blueprinting 3074 Servers and workstations 3075 Overhead projectors and beamers 3076 Other PROF and network equipment

307 PROF IT No.

3071 PROF Multifunctionals (fax, print, scan, copy, etc.)

Condition (circle) usable unusable usable unusable usable unusable usable unusable usable unusable usable unusable

404 SHA Video No. Condition (circle) 4041 DVD players and recorders usable unusable 4042 Blue-ray players and recorders usable unusable 4043 VCR players and recorders usable unusable 4044 Decoders and satellite receivers usable unusable 4045 Video and antenna equipment usable unusable Description

Description
5051 Retrofit LED lamps 5052 LED inc. luminaire HH

505 LAMPS LED No. Condition (circle) usable unusable usable unusable

Description Description
3081 CRT Monitors

308 IT CRT Monitors Condition (circle) No. usable unusable

5071 PROF Luminaires

406 SHA Cameras Description No. Condition (circle) 4061 Digital Still Camera (photo) usable unusable 4062 Video Camera (incl. photo function) usable unusable

5072 PROF LED Luminaires

507 PROF Luminaires No. Condition (circle) usable unusable usable unusable

Description
3091 LCD Monitors 3092 LED Monitors 3093 Small flat screens

309 IT Flat panel monitors Condition (circle) No. usable unusable usable unusable usable unusable

Description
7011 Small toys

407 CRT TV's Description No. Condition (circle) 4071 CRT TV's (incl. combi DVD, VCR) usable unusable

7012 Vehicle toys 7013 Small music toys

701 SHA Small Toys No. Condition (circle) usable unusable usable unusable usable unusable

401 SHA Small CE and accessoires Condition (circle) Description No. 4011 Headphones and headsets usable unusable 4012 Microphones usable unusable 4013 Adapters and power supply CE usable unusable 4014 Remote controls usable unusable 4015 Other small CE usable unusable

Description
4081 LCD TV's 4082 LED TV's 4083 Plasma TV's

408 Flat Display Panel TV's No. Condition (circle) usable unusable usable unusable usable unusable

702 IT Video Gaming No. Condition (circle) 7021 Game consoles (TV, Monitor connected) usable unusable 7022 Game consoles (portable) usable unusable 7023 Games consoles accessoires usable unusable 7024 Games (cards) usable unusable Description

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