| Name of Jurisdiction:_______________________________________ | |||||||||||||
| Sponsoring Agency:________________________________________ | |||||||||||||
| Date of Scheduled Show:____________________________________ | |||||||||||||
| Starting Time:______________________________________________ | |||||||||||||
| Person Completing Questionnaire:____________________________ | |||||||||||||
| Title:______________________________________________________ | |||||||||||||
| Telephone:________________________Fax:_____________________ | |||||||||||||
| E-Mail:____________________________________________________ | |||||||||||||
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Population:___________________
Community Type: Urban____Rural____Suburban____
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Population
Trends: ____________________________________________________________________ ____________________________________________________________________
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Brief Description of the
Community: (types of industry, density, media outlets, magnitude of traffic
problems, etc.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Reason for Sponsoring Road Show: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Number of Pedestrian Crashes/YR:___________
Pedestrian Fatalities/Yr.________
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Distribution of Crashes by
Pedestrian
Age: 0-4______ 5-9______ 10-15______ 15-19__ ____ 20-64______ 65+______ | |||||||||||||
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Distribution of Crashes by
Location:
Commercial/Business:__________Residential:_________Intersection:_
___
_____ | |||||||||||||
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Major Pedestrian Error Leading to
Crashes: ______________________________________________________________________________ ______________________________________________________________________________
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Major Motorist Error Leading to
Crashes: ______________________________________________________________________________ ______________________________________________________________________________
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Pedestrian Crash Trends:
Are crashes increasing, decreasing, changing demographics? ______________________________________________________________________________ ______________________________________________________________________________
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Sidewalk Policy: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Recent Pedestrian
Improvements: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Pedestrian Projects in
Transportation
Improvement Program: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Use of Traffic Calming
Devices:
(e.g. speed humps, roundabouts, etc.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Greatest Facility Concerns:
| ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Recent Pedestrian Safety
Initiatives: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Pedestrian Safety Education in
Schools: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Pedestrian Safety Enforcement
Activity: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Pedestrian Public Information
Efforts: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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Level of Citizen Interest in
Pedestrian
Safety: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Level of Official Support for
Pedestrian
Safety Programs: | ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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