Grade 4
Mathematics, Computing and Digital Literacy
Project Based Learning Week Program 2025
Thembelisha Preparatory School
Name: ____________________________ Date: _______________
Worksheet 2 Thursday, June 19, 2025
My Family Carbon Footprint Checklist/Survey
Understanding Our Impact on the Planet
This survey will help your family learn about the energy and resources you use
every day, and how it a ects our planet. Please work with an adult to
complete this checklist.
1 Electricity – Lighting 2 Electricity – Number of
Electronics
How many hours a day are your
lights on? How many electronic devices
Please tick one box that best (including phones and geysers) are
describes your family's habits used at the same time in your
home?
Please Please tick one box that best
Options
Tick describes your family's habits
1 to 4 Hours per
night Please
Options
5 to 10 Hours per Tick
night 1 to 5 devices
More than 10 Hours
6 to 10 devices
Often forget to
switch outside light 11 to 20 devices
20 or more devices
3 Cooking – Methods of Please
Options
Cooking Tick
Traditional (wood,
What is the most common method Coal or Open Fire)
of cooking in your house?
LP Gas
Please tick one box that best
describes your family's habits. Electricity
Mixed – Gas and
Electricity
4 Transportation 5 Waste Management
How many vehicles does your How does your family manage and
family use for daily travel (like going dispose of waste?
to work or school)?
Please tick one box that best Please tick one box that best
describes your family's habits. describes your family's habits.
Please Please
Options Options
Tick Tick
None (We Walk, Sort, Recycle,
cycle, or use public Reuse, and Reduce
transport) most of our waste
One vehicle Recycle some items
(e.g., on specific
Two vehicles days)
Three or more Waste is collected
vehicles and sent to a landfill
We burn some or all
of our waste
6 Water Use and Management We bury or compost
- Watering Grass some of our waste at
home
6.1 If you water grass or a garden,
what type of water do you use? 6.2 If you water grass or a garden,
how often do you do it?
Please tick one box that best Please tick one box that best
describes your family's habits. describes your family's habits
Please Please
Options Options
Tick Tick
Reused wastewater Often (Once or twice
(e.g., bathwater) a week)
Rarely (Once a
Fresh tap water month
We do not water our Never
grass or garden
7 Water Use and Management
- Washing and For Fun
7.1 How often does your family 7.2 In summer, how often do you
use water for washing clothes? or your family use water for playing
(e.g., swimming, water games)?
Please tick one box that best
describes your family's habits. Please tick one box that best
describes your family's habits.
Please
Options
Tick
Once a week or less Please
Options
Tick
Two or three times a
week Never
Almost every day Rarely (Once a
month or less)
We use a laundry Often (Once or twice
service or a week) Almost every
community wash day
area (not at home)
such as a river
Parent Signature:
_________________________________
Date:
_________________________________
