Montgomery County Pedestrian Safety Survey
The Association for Safe International Road Travel (ASIRT) is a non-profit, non-governmental organization whose mission is to improve the safety of travelers on the roads. ASIRT is coordinating a local initiative to make our community safer for pedestrians. Members of our community walk for leisure, exercise, and to houses of worship in our area. Unfortunately, people encounter “blackspots,” locations that are hazardous for pedestrians. To address this issue, ASIRT is working with the community to identify the problems and urge the county government to expeditiously remediate the areas of concern. If you have encountered a blackspot within the general region outlined in the map below, please fill out the survey below. The information you provide will allow us to identify the problematic areas and assist us in seeking a resolution from the county.
NOTE: Please describe ONE blackspot per section of the survey. You will have the option to report additional blackspots at the end.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Blackspot #1
What type of road safety issue did you encounter? Check all that apply.
Lack of sidewalks
Non-existent crosswalks
Inadequate lighting
Poorly designed roads
Disability access and concerns
Senior access and concerns
Speeding and distracted driving
Inadequate enforcement of traffic laws
Lack of traffic light
Other
Where did you encounter this issue? Please add any relevant information about this specific location (cross street, address, etc.) and the safety concern. The more details you can provide, the better.
Do you have photos of this blackspot? If so, please upload them.
Browse Files
Note: If you are unable to upload your photo and would like to share it, please send an email to isaacnadaner@gmail.com.
Cancel
of
If you have a solution in mind, kindly describe it.
Have you contacted anyone about this issue? If so, whom did you contact, and when (approximately)?
What was the response you received?
Do you know of other individuals who encounter this same issue whom we can contact? If so, please provide their contact information.
Rows
1
2
3
Name
Phone
Email
Would you like to report an additional blackspot?
*
Yes
No
Blackspot #2
What type of road safety issue did you encounter? Check all that apply.
Lack of sidewalks in residential areas
Non-existent crosswalks
Inadequate lighting
Poorly designed roads
Disability access and concerns
Senior access and concerns
Speeding and distracted driving
Inadequate enforcement of traffic laws
Lack of traffic light
Other
Where did you encounter this issue? Please add any relevant information about this specific location (cross street, address, etc.) and the safety concern. The more details you can provide, the better.
Do you have photos of this blackspot? If so, please upload them.
Browse Files
Note: If you are unable to upload your photo and would like to share it, please send an email to isaacnadaner@gmail.com.
Cancel
of
If you have a solution in mind, kindly describe it.
Have you contacted anyone about this issue? If so, whom did you contact, and when (approximately)?
What was the response you received?
Do you know of other individuals who encounter this same issue whom we can contact? If so, please provide their contact information.
Rows
1
2
3
Name
Phone
Email
Would you like to report an additional blackspot?
*
Yes
No
Blackspot #3
What type of road safety issue did you encounter? Check all that apply.
Lack of sidewalks in residential areas
Non-existent crosswalks
Inadequate lighting
Poorly designed roads
Disability access and concerns
Senior access and concerns
Speeding and distracted driving
Inadequate enforcement of traffic laws
Lack of traffic light
Other
Where did you encounter this issue? Please add any relevant information about this specific location (cross street, address, etc.) and the safety concern. The more details you can provide, the better.
Do you have photos of this blackspot? If so, please upload them.
Browse Files
Note: If you are unable to upload your photo and would like to share it, please send an email to isaacnadaner@gmail.com.
Cancel
of
If you have a solution in mind, kindly describe it.
Have you contacted anyone about this issue? If so, whom did you contact, and when (approximately)?
What was the response you received?
Do you know of other individuals who encounter this same issue whom we can contact? If so, please provide their contact information.
Rows
1
2
3
Name
Phone
Email
Back
Next
Do you consent to be quoted in our correspondence with the county government?
*
Yes, and you may use my name
No
Yes, but I would prefer to remain anonymous
Is there anything else you would like to add?
Submit
Should be Empty: