2021 Perry County Ohio Individual Transportation Survey 2019 Perry County Ohio Individual Transportation Survey Please complete the short following survey regarding transportation. Please complete ONLY if you are a Perry County Ohio Resident. OK Question Title * 1. How old are you? Under 18 18-30 31-44 45-59 60-69 70-79 80 or older OK Question Title * 2. What is your gender? Male Female Prefer not to answer Other (please specify) OK Question Title * 3. Are you a Veteran? Yes No Active Duty OK Question Title * 4. Including you, how many people are in your household? (Check on box) 1 2 3 4 5 6+ OK Question Title * 5. Please select the choice that BEST applies to you Employed outside your home Employed in your home Retired Student Unemployed Other (please specify) OK Question Title * 6. I consider myself (Check all that apply to you) Disabled Low Income Senior (60+) None of the above OK Question Title * 7. Do you use a cane, walker, wheelchair, and/or another mobility device to help you get around? Yes No OK Question Title * 8. What is your zip code? OK Question Title * 9. Is your principle employment in Perry County? Yes No If not, how many miles driven daily for work: OK Question Title * 10. In the past six months, which of the following statement(s) apply to your situation: (Check all that apply to you) I do not have a driver's license My driver's license is suspended I do not have car insurance I can't afford gasoline I do not have a vehicle I can't afford to use a taxi service None of these apply to me Other (please specify) OK Question Title * 11. Mark ALL of the transportation you or your family have used during the past 12 months to travel to work/appointments/shopping/social activities/etc: (Check ALL that apply to you) Perry Count Transit Other counties mass transit systems Carpool or vanpool Perry County Job & Family Services/senior agencies/Veteran's Services, etc. Other county Job & Family Services/senior agencies/Veteran's Services, etc. Private inter-city bus (such as Greyhound or Megabus or GoBus) Private taxi, Uber, Lyft (or similar) Car Share (Zipcar) Faith based organization (such as a church bus or van to go to services or activities) Ambulette Service (non-emergency medical transportation provided by a medical transportation company) Personal vehicle or ride with a friend/family member Bicycle or walk (other than for exercise) Volunteer transportation Amtrak (originating in Ohio) None Other (please specify) OK Question Title * 12. What is your opinion about public transportation provided by Perry County Transit? (Check all that apply to you) Fares too expensive Safety concerns Cleanliness Timeliness/Late Arrivals Excessive Ride Time Courtesy of employees Other (please specify) OK Question Title * 13. Has there been days and times you would have utilized public transportation if available? (check all that apply) 12am-6am 6am-9am 9am-12pm 3pm-6pm 6pm-9pm 9pm-12am Monday Monday 12am-6am Monday 6am-9am Monday 9am-12pm Monday 3pm-6pm Monday 6pm-9pm Monday 9pm-12am Tuesday Tuesday 12am-6am Tuesday 6am-9am Tuesday 9am-12pm Tuesday 3pm-6pm Tuesday 6pm-9pm Tuesday 9pm-12am Wednesday Wednesday 12am-6am Wednesday 6am-9am Wednesday 9am-12pm Wednesday 3pm-6pm Wednesday 6pm-9pm Wednesday 9pm-12am Thursday Thursday 12am-6am Thursday 6am-9am Thursday 9am-12pm Thursday 3pm-6pm Thursday 6pm-9pm Thursday 9pm-12am Friday Friday 12am-6am Friday 6am-9am Friday 9am-12pm Friday 3pm-6pm Friday 6pm-9pm Friday 9pm-12am Saturday Saturday 12am-6am Saturday 6am-9am Saturday 9am-12pm Saturday 3pm-6pm Saturday 6pm-9pm Saturday 9pm-12am Sunday Sunday 12am-6am Sunday 6am-9am Sunday 9am-12pm Sunday 3pm-6pm Sunday 6pm-9pm Sunday 9pm-12am OK Question Title * 14. What city/town, county or counties are the locations of the following services for you? Medical Employment Shopping Recreation Other OK Question Title * 15. Have you missed a medical appointment in the last 12 months due to lack of transportation? Yes No OK Question Title * 16. If you are on a medically necessary regimen such as dialysis, wound care, cancer treatment, or other treatments, do you experience difficulty finding transportation? Yes No OK Question Title * 17. Do you own a bicycle? Yes No OK Question Title * 18. If you do own a bicycle, how comfortable are you traveling along public roads? Very uncomfortable Uncomfortable Comfortable Very comfortable OK Question Title * 19. Do you or anyone in your household walk to local establishments? (grocery, pharmacy, post office, dining, or entertainment) Yes No OK Question Title * 20. OPTIONAL: Please provide Name and Contact Information OK DONE