Wheelchair Accessible transportation survey
                                                                    Julie Steward, 2019

 

1. What type of wheelchair do you use?
    ___ manual            ___ powered or motorized              ___ scooter

2. Do you travel outside of your home?
    ___ yes              ___ no

3. If you do not travel outside of your home, what are the reasons for this?
    ___ I do not have a way to go anywhere because accessible transportation isn't available when I need it.  
    ___ public transportation is not convenient for me.
    ___ a doctor has ordered that I should not leave my home.
    ___ I choose to stay at home.
    ___ other  please explain: _____________________________________________________________________________

4. If you do not travel outside of your home, would you like to?
    ___ yes              ___ no

5. If you do you travel outside your home, how often do you go out?
___ once per week              ___ two or three times per week              ___ five or more times per week             
___ daily              ___ more than once a day

6. When traveling outside your home, what means of transportation do you use?
    ___ I have my own vehicle and have no problems getting around with it.
    ___ other people help me get where I want to go.
    ___ I use public transportation and have no problems with it.
    ___ I use public transportation, but it is problematic for me.

7. What are problems you encounter when using public transportation?
    ___ I have no problems using public transportation.
    ___ scheduling rides is a hassle.
    ___ the vehicles used are not suitable for the wheelchair I use.
    ___ the rides are physically too rough for me.
    ___ I feel like people who provide this service are unfriendly to me.
    ___ other    please explain: _____________________________________________________________________________

8. Are there places you would like to go but are unable because accessible transportation isn't available when you need it?                  ___ yes              ___ no
    Where would you like go but feel you are unable to because accessible transportation isn't available when you need it?______________________________________________________________________

9. Please check if you have ever been prevented from going to activities listed below because accessible transportation isn't available when you need it.
___ a social event      ___ a sporting event    ___ a concert    ___ church    ___ a birthday party of a friend or relative    ___ a hair appointment    ___ a trip to the lake    ___ a trip to visit a friend or family member out of town                  ___ a funeral or celebration of life service    ___ dinner with a friend    ___ a movie    ___ a destination outside of Lawrence/your city    ___ other  please explain: _____________________________________________________________________________

10. If transportation was available that would comfortably accommodate you with the wheelchair you use, how would your life change?
    ___ I would experience no change.
    ___ I would be happier.
    ___ I would be healthier.
    ___ other  please explain: _____________________________________________________________________________

11. What cost would be appropriate for accessible transportation for
(a) in town travel _______? (b) out of town travel such as to Kansas City or Topeka ______?

12. Please describe how you feel your life would change if transportation was available to comfortably accommodate you with the wheelchair you use.

_____________________________________________________________________________________________

 

                                   Please scan and email completed survey to wegovans@gmail.com.