Copy of Transportation Survey
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1. Default Section
1
. Please check the public transportation systems you currently use.
Please check the public transportation systems you currently use.
A1 Taxi
SIL (Services for Independent Living)
Para-transit
OATS (Older Adults Transportation services)
Other
Please specify if other
2
. What type of disability do you have? (Check all that apply)
What type of disability do you have? (Check all that apply)
Physical
Cognitive
Hearing
Visual
Communication
Other
Please specify if other
3
. Do you use a wheelchair?
Do you use a wheelchair?
Yes
No
If yes, is it manual or power?
4
. How satisfied are you with your current transportation systems availability, cost and treatment of you by staff?
Not Satisfied
Moderately Satisfied
Fully Satisfied
Availability
*
How satisfied are you with your current transportation systems availability, cost and treatment of you by staff? Availability Not Satisfied
Availability
Availability
Availability
Availability Moderately Satisfied
Availability
Availability
Availability
Availability
Availability Fully Satisfied
Cost
Cost Not Satisfied
Cost
Cost
Cost
Cost Moderately Satisfied
Cost
Cost
Cost
Cost
Cost Fully Satisfied
Treatment by staff
Treatment by staff Not Satisfied
Treatment by staff
Treatment by staff
Treatment by staff
Treatment by staff Moderately Satisfied
Treatment by staff
Treatment by staff
Treatment by staff
Treatment by staff
Treatment by staff Fully Satisfied
5
. How many activities/appointments per week are you unable to attend due to limited transportation?
How many activities/appointments per week are you unable to attend due to limited transportation?
0-1
1-3
4-6
More than 6
6
. What causes you to miss activities/appointments?
What causes you to miss activities/appointments?
Limited Space
Days of Operation
Times of Operation
Location of Home
Location of Destination
Other
Please specify if other
7
. Is physical assistance adequate to meet your needs?
Is physical assistance adequate to meet your needs?
Yes
No
If no, please specify type of assistance needed:
8
. Does the Para-transit application process inhibit you from using their services?
Does the Para-transit application process inhibit you from using their services?
Yes
No
Not Applicable
9
. Would you be interested in a comprehensive brochure of all the public transportation systems in Columbia if it were available?
Would you be interested in a comprehensive brochure of all the public transportation systems in Columbia if it were available?
Yes
No
Additional comments or concerns about Columbia's public transportation system:
10
. If you would like to contact us, we are occupational therapy students at MU. Here are our email addresses:
Whitney wshdkd@mizzou.edu
Kelli kebck5@mizzou.edu
Megan mcsm97@mizzou.edu
If you would like to be contacted about this project please provide your information:
If you would like to contact us, we are occupational therapy students at MU. Here are our email addresses: Whitney wshdkd@mizzou.edu Kelli kebck5@mizzou.edu Megan mcsm97@mizzou.edu If you would like to be contacted about this project please provide your information:
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