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Infrastructure Survey

Description

In an effort to better communicate with our community partners regarding infrastructure issues in your neighborhood or public space, we have created this short survey. Your input will help us address infrastructure issues in Fort Wayne. Your participation is important and should only take a few minutes. Thank you!

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email Address *This question is required. This question requires a valid email address.

4. Phone Number *This question is required.

5. Infrastructure access location - the area of concern. Write the address or intersection in the comment box. This can be any public space, to help someone be in the public space more safely or travel where they currently cannot, to make the infrastructure more inclusive, usable, efficient, reliable, and enables mobility. *This question is required.

6. Please describe the accessibility issue. Check the appropriate box and provide a description in the comment box. *This question is required.

Pedestrian Sidewalks
Street Crossing
Crosswalk
Islands or Medians
Curb Cuts or Ramps
Detectable Warning
Pedestrian Signal or Pushbutton
Bus Stop or Boarding Shelters
Pedestrian Rail Crossing
Pedestrian Handrails or Guardrails
Pedestrian Stairways
Fort Wayne Trails

Comments

7. If your site is listed for review, would you be interested in attending a meeting? If no, why not? *This question is required.

Comments

8. How far is the nearest grocery? *This question is required.

9. How far is the nearest health clinic? *This question is required.

10. How far is the nearest hospital? *This question is required.

11. If you have reported issues in the past, please select which option below. Select all that apply.

I have never reported an issue.
311
Neighborhood Meetings
Public Works Department
Other means that you reported the issue. Write in the comments.

Comments

12. Optional Question. How would you best describe your limitations?

Comments