1. What community do you live in:
2a. Name(s) (optional):
2b. E-mail address:
3. Age:
10 and below
11-16
17-25
26-35
35-50
51-70
Over 70
Sex:
Female
Male
No Input
4. Briefly describe any professional training, life training, or life experience
related to the traffic safety issue which shapes your opinion. (160 char)
5. In your view, what are the most pressing traffic safety problems in your community? Why do you feel that way? (280 char)
6. Which problems do you feel should be addressed energetically as a
community issue, rather than an individual issue? (280 char)
7. What do you see as a possible way (or ways) to address these concerns? (280 char)
8. What services or oganizations are you aware of in your community,
that address some or all of these concerns? (160 char)
9. How do you get your updated information about traffic safety issues
or about specific traffic safety initiatives sponsored by community organizations? (160 char)
10. In your opinion, how do others in your community access or receive this
type of information? (140 char)
11a. Rate the top five pressing safety problems in your community, with number one (1)
being the most pressing.
a. Dangerous intersections
b. Engineering, roadway, or other infrastructure problems - unsafe streets
Impaired Driving due to:
c. Alcohol
d. Other substance abuse
e. Fatigue
f. Inattentive driving
g. Speeding
Lack of safety belt use by:
h. Children
i. Adults
j. Pedestrian and Bicycle Safety
1.
2.
3.
4.
5.
Ignorance or non-adherence to traffic laws:
k. Disregard for stop signs
l. Following too closely
m. Disregard for traffic signals
n. Failure to yield right-of way
o Vehicle factors (unsafe vehicles)
p. Unsafe backing
q. Refusal to uield to emergency vehicles
r. Other (please provide examples)
11b. If you selected "Other", please enter examples:
12. List any suggestions for other uses for the Community Traffic Safety site on the Internet. (280 char)