* 1. What is your postal code?

A postal code is required to complete this survey.

Postal codes cannot be used to identify your place of residence. This information is being used to ensure that all neighbourhoods in Rothesay are represented in the survey.  

* 2. What issues limit you from going out?

  1 (Not a problem at all) 2 3 4 5 (Major problem) No response
Concern over safety from crime
Concern over safety from falls, i.e. ice and snow on sidewalks, loose gravel on roads and walkways
Lack of sidewalks
Accessible sidewalks (ramps)
Stairs
Heavy doors
Lack of washrooms
Lack of seating/shelter
Poor lighting
Pedestrian crossings
Signage
Other (Please specify) a. 
b. 

* 3. In your opinion, what should the Town do to address these issues?

* 4. Have any of the following limited your use of transportation? 

My own vehicle (car, truck, motorcycle, etc.)

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Parking availability
Snow removal
Road upkeep
Traffic management and travel distance

* 5. Have any of the following limited your use of transportation?

Active transportation (walking, running, bicycling)

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Safety concerns (streets, sidewalks, trails)

* 6. Have any of the following limited your use of transportation?

Bus / Taxi / Shuttle / Accessible Transportation options

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Cost
Personal safety concern
Physical accessibility
Complete and accessible information available to users about transit routes, schedules, and fares
Other (Please specify below) a.
b.

* 7. In your opinion, what should the Town do to address these issues?

* 8. What type of housing are you living in now?

* 9. If you were going to leave your present home, what type of housing would you look for?

* 10. Rate each of the following issues that could prevent you from remaining in your home now or in the future. 

  1 (not a problem at all) 2 3 4 5 (major problem) No Response
Home maintenance
Yard maintenance
Snow clearing
Property/Water and sewage costs
Personal safety - health reasons
Personal safety - crime
Loss of spouse or loved one
Access to services (grocery shopping, drugs, medical appointments)
Retrofit expenses (main level bathroom, bedroom, chairlift, etc.)
Other (Please specify below) a.
b

* 11. In your opinion, what should the Town do to address these issues?

* 12. Which of the following interest you?

* 13. Rate each of the following issues that could be a barrier for you participating in social/cultural activities.

  1 (not a problem at all) 2 3 4 5 (major problem) No Response
Cost
Location
Personal interest
Transportation
Health and mobility
Vision and/or hearing difficulties
Caregiving responsibilities 
Event scheduling
No one to go with
Accessibility (No adapted washrooms, ramps, good lighting, etc.)
Other (Please specify below) a.
b.

* 14. In your opinion, what should the Town do to address these issues?

* 15. Which of the following concerns do you have now or see yourself having in this community? 

  1 (not a problem at all) 2 3 4 5 (major problem) No Response
Courtesy in retail or municipal buildings
Being valued by the community for my wisdom and for past, present, and future contributions
Respect by Youth
Respect by Adults
Respect by family member
Being included in community activities for families
Opportunities for participation in intergenerational activities
Opportunities to interact with people of different cultural backgrounds
Other (Please specify) a.
b.

* 16. In your opinion, what should the Town do to address these issues?

* 17. Do any of the following  (now or in the future) negatively impact your sense of belonging in your community?

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Age
Language
Sexual orientation
Being a newcomer
Disability
Faith
Other (Please specify below) a.
b.

* 18. What issues prevent you from helping others/volunteering?

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Health/Mobility
Time
Expense
No interest/Lack of activities to choose from
Finding appropriate volunteer opportunities for my skills and talents
Transportation
Lack of appreciation
Difficulty to find information about opportunities
Other (Please specify) a. 
b.

* 19. In your opinion, what should the Town do to address these issues?

* 20. What would be the best way for the Town to inform you about activities and services available to older adults? 

* 21. In the last 12 months, how did you get information you needed from the community?

  1 (did not use) 2 3 4 5 (use frequently) No Response
One-to-one from a trusted friend or family member
Television/Radio
Newspaper
Flyers/Mail
Internet (email, websites, Facebook, blogs)
Library
Church bulletins
Prime Time Magazine
KV Style
Other (Please Specify) a. 
b. 

* 22. What else would you like to tell us about living in Rothesay that could make it better?

* 23. Are you completing this survey on behalf of some one? 

* 24. In which age cohort are you?

* 25. What is your gender?

* 26. Are you...

* 27. Do you presently drive a motor vehicle?

* 28. What is the highest education level you have attained?

* 29. As you think about your future years, what worries you?

  1 (Not a problem at all) 2 3 4 5 (Major problem) No Response
Financial concerns
Losing my driver's license
Losing my independence
Declining health
Difficulty physically getting around
Falling 
Moving to more suitable housing 
Finding the appropriate care as I age
No one to care for me
Growing old alone/being lonely
Death and dying 
Dementia 
Other (Please specify) a. 
b. 

* 30. Which of the following best describes your current employment status?

* 31. Are there any other comments you would like to share with the Age Friendly  Committee of Rothesay?

* 32. Which of the following best describes your current relationship status?

* 33. Date:

Date / Time
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