Community Walkability Checklist
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1. How walkable is your community?
1
. Please enter the start address or intersection you surveyed. Be specific including city and zipcode.
Please enter the start address or intersection you surveyed. Be specific including city and zipcode.
2
. Please enter the stop address or intersection you surveyed. Be specific including city and zipcode.
Please enter the stop address or intersection you surveyed. Be specific including city and zipcode.
3
. Please identify all the facilities/housing that are in the location and surrounding area:
Please identify all the facilities/housing that are in the location and surrounding area:
Community Center
Convenience Store
Fast Food Restaurant
Grocery Store
Housing - Mobile Homes
Housing - Multi-Family
Housing - Single Family
Industrial
Office/Institutional Building
Other Restaurant/Cafe
Other Retail Store
Park
Produce Market
Recreation/Exercise Facility
Vacant/Undeveloped
Walking/Biking Trail
Other (please specify)
4
. Sex:
Sex:
Male
Female
5
. Home Zip Code:
Home Zip Code:
ZIP:
6
. Age:
Age:
19 and Under
20 to 24 Years
25 to 34 Years
35 to 44 Years
45 to 54 Years
55 to 59 Years
60 and Older
7
. Please rank the following questions:
Excellent
Very Good
Good
Fair
Poor
Did you have room to walk?
*
Please rank the following questions: Did you have room to walk? Excellent
Did you have room to walk? Very Good
Did you have room to walk? Good
Did you have room to walk? Fair
Did you have room to walk? Poor
Was it easy to cross streets?
Was it easy to cross streets? Excellent
Was it easy to cross streets? Very Good
Was it easy to cross streets? Good
Was it easy to cross streets? Fair
Was it easy to cross streets? Poor
Did drivers behave well?
Did drivers behave well? Excellent
Did drivers behave well? Very Good
Did drivers behave well? Good
Did drivers behave well? Fair
Did drivers behave well? Poor
Was it easy to follow safety rules?
Was it easy to follow safety rules? Excellent
Was it easy to follow safety rules? Very Good
Was it easy to follow safety rules? Good
Was it easy to follow safety rules? Fair
Was it easy to follow safety rules? Poor
Was your walk pleasant?
Was your walk pleasant? Excellent
Was your walk pleasant? Very Good
Was your walk pleasant? Good
Was your walk pleasant? Fair
Was your walk pleasant? Poor
8
. Did you have room to walk?
Did you have room to walk?
Yes
No - Sidewalks or paths started and stopped
No - Sidewalks were broken or cracked
No - Sidewalks were blocked with poles, signs, shrubbery, dumpsters, etc.
No - No sidewalks
No - No paths, trails or shoulders
No - Too much traffic
No - Sidewalks very narrow
No - No space seperating walk from roadway
No - Sidewalks were blocked with poles, signs, etc.
Other (please specify)
9
. Please identify the location of problems:
Please identify the location of problems:
10
. Was it easy to cross streets?
Was it easy to cross streets?
Yes
No - Road was too wide
No - Traffic signals made us wait too long
No - Traffic signals did not give us enough time to cross
No - Needed striped crosswalks
No - Parked cars blocked view of traffic
No - Trees or plants blocked view of traffic
No - Need traffic signals
No - Needed curbs, curb ramps or ramps needed repair
Other (please specify)
11
. Please identify the location of problems:
Please identify the location of problems:
12
. Did drivers behave well?
Did drivers behave well?
Yes
No - Backed out of driveways without looking
No - Did not yield to people crossing the street
No - Turned into people crossing the street
No - Drove too fast
No - Speed up to make it thorough traffic lights
No - Drove through traffic lights
No - Too many cars
Other (please specify)
13
. Please identify the location of the problems.
Please identify the location of the problems.
14
. Was your walk pleasant?
Was your walk pleasant?
Yes
No - Needed more grass, flowers, or trees
No - Scary dogs/dogs running free
No - Scary people
No - Not well lighted
No - Dirty, lots of litter or trash
No - Drivers violating traffic laws
No - Dirty air due to automoblile exhaust
No - No shade
No - No benches
No - No water fountains
No - Sidewalks/trails not well maintained
15
. Was it easy to follow safety rules? Could you...
Yes
No
Cross at crosswalks or where you could see and be seen by drivers?
*
Was it easy to follow safety rules? Could you... Cross at crosswalks or where you could see and be seen by drivers? Yes
Cross at crosswalks or where you could see and be seen by drivers? No
Stop and look left, right and then left again before crossing the street?
Stop and look left, right and then left again before crossing the street? Yes
Stop and look left, right and then left again before crossing the street? No
Walk on sidewalks or shoulders facing traffic where there were no sidewalks?
Walk on sidewalks or shoulders facing traffic where there were no sidewalks? Yes
Walk on sidewalks or shoulders facing traffic where there were no sidewalks? No
Cross with the light?
Cross with the light? Yes
Cross with the light? No
16
. What do you believe is the most dangerous location along this route?
What do you believe is the most dangerous location along this route?
17
. What do you believe is the most unpleasant element along this route?
What do you believe is the most unpleasant element along this route?
18
. Please give us your comments and suggestions to make improvements, be specific:
Please give us your comments and suggestions to make improvements, be specific:
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