Residential Windshield Survey Form
Document visual observations of a residential neighborhood or area from outside the property. Please complete all fields based on what you observe during your survey.
Survey Location (Address or Area Name)
*
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Observer Name
*
Observer Contact (Email or Phone)
*
Area Type
*
Urban
Suburban
Rural
General Housing Condition
*
Well-kept
Fair
Poor
Visible Maintenance or Safety Concerns
Broken windows
Graffiti
Overgrown lawns
Damaged sidewalks
Litter or debris
Other
Neighborhood Environment Assessment
*
Rows
Excellent
Good
Fair
Poor
Cleanliness
1
2
3
4
Presence of green spaces
5
6
7
8
Noise level
9
10
11
12
Traffic safety
13
14
15
16
Overall Neighborhood Condition
*
1
2
3
4
5
Observation Summary / Comments
Submit Survey
Should be Empty: