Rural Route Evaluation Data Collection Form
Submit observations and assessments for rural route evaluations. Please complete all applicable fields for each inspection.
Route Being Evaluated
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Name
*
First Name
Last Name
Route Segment or Location
*
Road Surface Condition
*
Excellent
Good
Fair
Poor
Accessibility or Travel Issues
None
Blocked Access
Flooding
Overgrown Vegetation
Other
Signage and Markings Condition
*
All clear and visible
Some faded or missing
Obstructed or damaged
Maintenance or Hazard Observations
Overall Route Quality
*
1
2
3
4
5
Additional Notes
Submit Evaluation
Should be Empty: