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Welcome!  
We each take many trips throughout our day and week; to work, school, the grocery store, the library, meetings and many others. The 5 minute survey below will assess your experience with and interest in active transportation (walking, biking, etc.) to complete your typical short trips.

Please complete each question either by selecting an answer or writing a response in the blank.

When finished select “Submit”, your answers will be emailed to the Fitness Council of Jackson.

One to two weeks after you complete the survey you will receive a “Personalized Active Transportation Plan” in the mail that includes tips for making biking and walking part of your daily routine and map showing walking and biking routes to the locations you most commonly travel.

Name        

Email Address:                                                                                                                                                                                                                                                                                                      
Home Address:     City:     Zip           

Employer Name (if applicable):

Work Address:    City:  Zip                                                      

Distance from work (miles)                                                                                                                     

1. Please indicate the extent to which you currently use each of the following for short trips (less than 5 miles)

All of the time Most of the time  Some of the time  Never  
Walking:
Jogging 
Bicycling   
Public Transit 
Drive Alone 
Carpooled  

Other (please specify)  

2. Please indicate the extent to which you might try each of the following active transportation modes for completing trips less than 5 miles, even if only part of the way and/or on a seasonal basis.

Very Interested   Somewhat Interested Not Interested Don't Know/Can't Say  
Walking:
Jogging
Bicycling 
Public Transportation

Other Non Motorized Please specify:

 

3. How did you travel to work today?  If you used more than one form of transportation, 
show method used for longest (distance) part of journey.

walked    jogged/ran    bicycled     public transit     drove alone 

carpooled        other (please specify)
 

4. Please indicate the extent to which you have ever tried the following non-motorized ("active transportation")
modes as a means of getting to and from  work at least part of the way: 

Many Times A Few Times  Never
Walking:
Jogging
Bicycling 
Public Transportation

Other Non Motorized Please specify:

5. Please indicate the extent to which each of the following is an important factor currently limiting your use of active transportation modes (i.e. walking, jogging, bicycling) for short trips (less than 5 miles).
 (Check one in each line)                                   

 Very Important Somewhat Important Not Important Don't Know/Can't Say
Distance to/from work too great 
Not enough time to get to and from work
Unsafe traffic conditions  
Fear of personal assaults/muggings
No convenient route   
Lack of storage space at work for commuting equipment and clothing
Poor security of storage space
Lack of change/shower facilities at work 
Don't own or have access to equipment or special clothing needed
Carrying materials to work

Other (please specify)

 

6. Please indicate the extent to which you think that using some form of active transportation (e.g., walking, jogging, bicycling), for at least a portion of a trip, might be beneficial for each of the following reasons:

Agree strongly Agree somewhat Disagree somewhat Disagree strongly Don't know/Can't Say
Good for my personal health and fitness
Good for the environment
Good for my personal happiness
Helps reduce my personal travel expense
Good for my employer's productivity and/or profit 

  

7. Please indicate if you own or have ready access to any of the following: (check all that apply) 
A bicycle suitable for daily riding
Sturdy, comfortable walking/running shoes       
Clothing suitable for outdoor riding in wet/rain weather    
Clothing suitable for outdoor riding in winter
Other forms of active transportation gear/equipment (please specify)

8. Please indicate your current general level of physical fitness as it might affect your ability to use active transportation for short trips (less than 5 miles)

Very fit           Somewhat fit           Not fit              Don't know/can't say   

 

9. Please indicate the extent to which you might wish/need to have some training or skill development for each of the following modes of active transportation if you were to use them for trips of less than 5 miles.

 No training needed Need Minor Training Need Significant Amount of Training Don't Know/Can't Say
Bicycling
Winter Commuting
Public Transit

Other (Please Specify)

 

10. Please name the places you commonly go during your typical week and workday. Be as specific as possible since we will be plotting these locations on a map. (Examples: Polly’s on Spring Arbor Rd., Foote Hospital, Fazoli’s on West Ave., Frost Elementary School, Cascades Park)      
   
Restaurants/Food        
  
Meetings    
   
Errands/Other

11.What other reasons might be currently limiting the extent to which you travel
using active transportation for short trips?
 

12.To what extent are you interested in finding out more about active transportation modes that
might be available to you?
Very interested   Somewhat interested    Not interested          Don't know/can't say

13. To what extent would you be interested in helping promote and support active transportation 
initiatives in our organization?
Very interested   Somewhat interested    Not interested          Don't know/can't say

What age group are you in?  
0-19       
20-29     
30-39     
40-49      
50-59      
Over 59               

Note: The Fitness Council of Jackson tries its best to suggest routes that are safe for all levels of walkers and bicyclists. However, everyone's comfort level is different and a suggested route on your Personalized Active Transportation Plan may not be the best choice for you. Please use the Plan as a guide and if you find we suggested a route you don't consider safe, please let us know so we can make corrections.  

                     Foot Energy is a program of 
The Fitness Council of Jackson   225 N. Jackson St   Jackson, MI 49201    517-990-9798  email: info@fitnesscouncil.org