Please complete page for the entire walkable area on your survey map.
Day of week: _______________ Time observation began: ________ a.m. / p.m.
Date: _____________________ Time observation ended: ________ a.m. / p.m.
Directions: Place a checkmark below next to any items that are a problem for walkers and note:
- What might especially be a problem for a child, senior or person with disabilities?
- Note landmarks, streets or sides of streets (north, south, east or west) on the blank line to the right of each item you check.
Problems for walkers / Location
☐ Car speeds are too fast ___________________________
☐ There is too much traffic ___________________________
☐ Drives are distracted (for example, using cell phones) ___________________________
☐ There is loitering or suspicious/criminal activity ___________________________
☐ There are unleashed dogs ___________________________
☐ There are unclear signs or directions for drivers or pedestrians __________________________
☐ Other (please specify) ___________________________________________
Overall rating of safety in walk survey area:
☐ Excellent ☐ Good ☐ Fair ☐ Poor