SurveyMonkey Powered Online Survey

1. What best describes you?

What best describes you? Individual with a disability

Family member or friend of an individual with a disability

City resident

Merchant or businessperson

Visitor

2. Overall, how would you rate the current level of accessibility to city buildings?

Overall, how would you rate the current level of accessibility to city buildings? Good

Average

Below Average

Poor

3. Overall, how would you rate the current level of accessibility to city park facilities?

Overall, how would you rate the current level of accessibility to city park facilities? Good

Average

Below Average

Poor

4. Overall, how would you rate the current level of accessibility to city sidewalks?

Overall, how would you rate the current level of accessibility to city sidewalks? Good

Average

Below Average

Poor

5. Please list any specific buildings or facilities which you have accessibility concerns and describe the nature of the concern:

Please list any specific buildings or facilities which you have accessibility concerns and describe the nature of the concern:

6. Please list any specific parks which you have accessibility concerns and describe the nature of the concern:

Please list any specific parks which you have accessibility concerns and describe the nature of the concern:

7. Please list any specific curb, sidewalk or crossing locations where you have accessibility concerns and describe the nature of the concern:

Please list any specific curb, sidewalk or crossing locations where you have accessibility concerns and describe the nature of the concern:

8. If the city were to make accessibility improvements to curbs and sidewalks, how would you rank the following priorities?

	Highest Priority	High Priority	Medium Priority	Lower Priority	Lowest Priority
Commercial Areas	*If the city were to make accessibility improvements to curbs and sidewalks, how would you rank the following priorities? Commercial Areas Highest Priority	Commercial Areas High Priority	Commercial Areas Medium Priority	Commercial Areas Lower Priority	Commercial Areas Lowest Priority
City Facilities	City Facilities Highest Priority	City Facilities High Priority	City Facilities Medium Priority	City Facilities Lower Priority	City Facilities Lowest Priority
Bus Stops	Bus Stops Highest Priority	Bus Stops High Priority	Bus Stops Medium Priority	Bus Stops Lower Priority	Bus Stops Lowest Priority
Schools	Schools Highest Priority	Schools High Priority	Schools Medium Priority	Schools Lower Priority	Schools Lowest Priority
Residential Areas	Residential Areas Highest Priority	Residential Areas High Priority	Residential Areas Medium Priority	Residential Areas Lower Priority	Residential Areas Lowest Priority

9. If the city were to construct, replace or retrofit curb ramps how would you rank the following priorities?

	Highest Priority	High Priority	Medium Priority	Lower Priority	Lowest Priority
Installing ramps at locations without curb ramps.	*If the city were to construct, replace or retrofit curb ramps how would you rank the following priorities? Installing ramps at locations without curb ramps. Highest Priority	Installing ramps at locations without curb ramps. High Priority	Installing ramps at locations without curb ramps. Medium Priority	Installing ramps at locations without curb ramps. Lower Priority	Installing ramps at locations without curb ramps. Lowest Priority
Replacing existing ramps that are too steep or unsafe.	Replacing existing ramps that are too steep or unsafe. Highest Priority	Replacing existing ramps that are too steep or unsafe. High Priority	Replacing existing ramps that are too steep or unsafe. Medium Priority	Replacing existing ramps that are too steep or unsafe. Lower Priority	Replacing existing ramps that are too steep or unsafe. Lowest Priority
Adding ramps to pedestrian crossings where one or more ramps are missing.	Adding ramps to pedestrian crossings where one or more ramps are missing. Highest Priority	Adding ramps to pedestrian crossings where one or more ramps are missing. High Priority	Adding ramps to pedestrian crossings where one or more ramps are missing. Medium Priority	Adding ramps to pedestrian crossings where one or more ramps are missing. Lower Priority	Adding ramps to pedestrian crossings where one or more ramps are missing. Lowest Priority
Installing detectable warnings (raised truncated domes).	Installing detectable warnings (raised truncated domes). Highest Priority	Installing detectable warnings (raised truncated domes). High Priority	Installing detectable warnings (raised truncated domes). Medium Priority	Installing detectable warnings (raised truncated domes). Lower Priority	Installing detectable warnings (raised truncated domes). Lowest Priority
Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe.	Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe. Highest Priority	Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe. High Priority	Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe. Medium Priority	Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe. Lower Priority	Retrofitting existing ramps that deviate slightly from current standards but are otherwise safe. Lowest Priority

10. Are you familiar with Accessible Pedestrian Signals (signals that provide audible information that help individuals with visual impairments cross the street)?

Are you familiar with Accessible Pedestrian Signals (signals that provide audible information that help individuals with visual impairments cross the street)? Yes

11. Are there any specific locations where you believe accessible pedestrian signals would be helpful to cross streets?

Are there any specific locations where you believe accessible pedestrian signals would be helpful to cross streets?

12. How would you rate the current availability of accessible on-street parking?

How would you rate the current availability of accessible on-street parking? Good

Average

Below Average

Poor

13. Are there any specific locations where you believe accessible on-street parking should be provided?

Are there any specific locations where you believe accessible on-street parking should be provided?

14. If you experience accessibility problems with city sidewalks, facilities or city programs, are you aware of who in the city to contact?

If you experience accessibility problems with city sidewalks, facilities or city programs, are you aware of who in the city to contact? Yes

15. Are you now, or were you ever unable to participate, access information or obtain city services due to any of the following circumstances?

Are you now, or were you ever unable to participate, access information or obtain city services due to any of the following circumstances? Facility not accessible Program not accessible Transportation not provided	Sign language interpreter not provided Materials not available in alternate format (Braille, large print or electronic) Assistive Listening Device not provided	City website not accessible
Other (please specify)

16. If you answered yes to the question above, please describe the situation and circumstances:

If you answered yes to the question above, please describe the situation and circumstances:

17. Do you have any additional comments or concerns?

Do you have any additional comments or concerns?

18. If the city were to hold a meeting to discuss and/or prioritize accessibility improvements would you be interested in participating?

If the city were to hold a meeting to discuss and/or prioritize accessibility improvements would you be interested in participating? Yes

19. May we contact you if we have further questions?

May we contact you if we have further questions? Yes

20. Please provide your contact information (optional):

Please provide your contact information (optional): Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

1. City of Mill Valley Community Survey