Community Walkability Checklist 1. How walkable is your community? Question Title * 1. Please enter the start address or intersection you surveyed. Be specific including city and zipcode. Question Title * 2. Please enter the stop address or intersection you surveyed. Be specific including city and zipcode. Question Title * 3. 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) Question Title * 4. Sex: Male Female Question Title * 5. Home Zip Code: ZIP: Question Title * 6. 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 Question Title * 7. Please rank the following questions: Excellent Very Good Good Fair Poor Did you have room to walk? 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 Question Title * 8. 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) Question Title * 9. Please identify the location of problems: Question Title * 10. 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) Question Title * 11. Please identify the location of problems: Question Title * 12. 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) Question Title * 13. Please identify the location of the problems. Question Title * 14. 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 Question Title * 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? 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 Question Title * 16. What do you believe is the most dangerous location along this route? Question Title * 17. What do you believe is the most unpleasant element along this route? Question Title * 18. Please give us your comments and suggestions to make improvements, be specific: Done