Name:
___________ Date:___________ |
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Read over the checklist
before you go, and as you walk note the locations of
things you would like to change. Location of Your Walk: From: _______________________ To: __________________ |
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1. Did you have room to walk?
__________ Yes ___ No ___ Sidewalks started and stopped Yes ___ No ___ Sidewalks were broken or cracked Yes ___ No ___ Sidewalks were blocked with poles, signs, shrubbery, dumpsters Yes ___ No ___ No sidewalks, paths, or shoulders Yes ___ No ___ Too much traffic? Yes ___ No ___ Something else? _________________________________________________ Locations of problems: _______________________________ |
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2. Was it easy to cross
streets? Yes ___ No ___ Road was too wide Yes ___ No ___ Traffic signals made us wait too long or did not give us enough time to cross Yes ___ No ___ Needed striped crosswalks or traffic signals Yes ___ No ___ Parked cars blocked our view of traffic Yes ___ No ___ Trees or plants blocked our view of traffic Yes ___ No ___ Needed curb ramps or ramps needed repair Yes ___ No ___ Something else? _______________________ Locations of problems: _____________________ |
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3. Did drivers behave well? Backed out of driveways without looking Yes ___ No ___ Did not yield to people crossing the street Yes ___ No ___ Turned into people crossing the street Yes ___ No ___ Sped up to make it through traffic lights or drove through red lights Yes ___ No ___ Something else? _______________________ Locations of problems: ________ |
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4. Was it easy to follow
safety rules? Could you ... Cross at crosswalks or where you could see and be seen by drivers? Yes ___ No ___ Stop and look left, right and then left again before crossing streets? Yes ___ No ___ Cross with the light? Yes ___ No ___ Cross with the help of a crossing guard? Yes ___ No ___ Locations of problems: ____________________ |
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5. Was your walk pleasant? Needed more grass, flowers or trees Yes ___ No ___ Scary dogs Yes ___ No ___ Scary people Yes ___ No ___ Not well lighted Yes ___ No ___ Dirty, lots of litter or trash Yes ___ No ___ Something else? ___________________ Locations of problems: _________________ How does your neighborhood stack up? number of Yes answers: __________ number of No answers:
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