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PROJECT INFO
Project Name:
Municipality (ies):
County (ies):
Brief project description:
PURPOSE
What is the purpose of this project? Circle all that apply
Reduce congestion Improve vehicle/driver safety System linkage/network
Economic development Improve bicycle/pedestrian capacity or safety
Change to current design standards Other_______________
COMMUNITY FACILITIES
Are there any of the following facilities within mile of the proposed project? Circle all that apply
School Park Hospital Fire Station Community/Rec Center
Church Bank Transit Stop Police Station Public Housing
Grocery Library Laundromat Senior Center Community Pool
Other Cultural Resource (town gathering spot, historic building / monument) Please describe:
ACCESS
Will the project alter access to any of the community facilities described above?
For vehicles Yes No Dont Know
(e.g., driveway changes / restrictions, introduction of median, create severed road/cul-de-sac)
For pedestrians/cyclists/other non-auto Yes No Dont Know
(e.g., jersey barrier, channeling to crossing, create severed road/cul-de-sac)
If Yes for either question, please describe:
Will the project impact driveways / parking lots? Yes No Dont Know
Will the project impact emergency access? Yes No Dont Know
Is there a bus/transit stop located along the project? Yes No
(The local planner / transit authority can assist on this and the next question)
How will the project change the availability or convenience of obtaining transit services?
Increase Decrease Stay the same Dont Know
COMMUNITY CHARACTERISTICS
The project area consists primarily of:
Residential Commercial Industrial
Please provide a brief description of the area:
(e.g., cohesive older residential, with a few commercial uses, such as a drug store)
Does the area surrounding the project appear to be low income? Yes No Dont Know*
Does the area around the project appear to have minority populations? Yes No Dont Know*
Members of the following populations observed. Circle all that apply
African-American Asian Hispanic Native American Other__________ Dont Know*
Does the project area have a considerable number of individuals from the following populations?
Elderly Children Disabled Dont Know*
Describe the level of pedestrian activity in the area.
High Medium Low Dont Know*
Is there bicycle activity in the area? Yes No *Dont Know
COMMUNITY COHESION
Will the project require relocation of the following? Circle all that apply and indicate number affected
Residences Businesses Cemetery / graves
Community Facilities (specify) Dont Know
Will the project create a barrier / divide an area / neighborhood? Yes No Dont Know
(create gaps by taking homes, introduce structural barriers such as
bridges, jersey barriers, noise walls)
* Not enough information to make a determination due to not being in the field at the time which this information could be observed or other timing issue.
PEDESTRIAN/BICYCLE SAFETY
Are there currently sidewalks along the facility? Yes No N/A (new loc.)
Proposed as a part of the project? Yes No Dont Know
Are there currently bike lanes / paths? Yes No N/A
Proposed as a part of the project? Yes No Dont Know
Does the project include widening the road? Yes No N/A
Will the project include a median to provide a crossing island refuge? Yes No Dont Know
How will the speed limit be changed? Increase Decrease Stay the same
Proposed speed limit _____mph
Describe other project features that may improve or decrease pedestrian / bicycle safety in the area:
(e.g., crosswalks, pedestrian signals, separation of road and sidewalk, driveway restrictions)
VISUAL IMPACTS
Are there large / mature trees located close to the existing road? Yes No
Will the project maintain or remove existing plantings? Maintain Remove Dont Know
Is there development (houses, businesses) close to the existing road? Yes No
Will the project include a median? Yes No
Will the median be landscaped? Yes No
What is terrain like? Flat Rolling Mountainous
Does the project include any roads designated as scenic byways? Yes No
OTHER
Are there dense residential clusters that may need noise analysis? Yes No
Will the project cross over or closely parallel a rail line? Yes No
If Yes, describe the configuration and proximity to the rail line:
If residents approached you with questions or if there are existing community issues not touched on by this survey, please briefly describe:
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