QUESTIONNAIRES FOR ROAD SAFETY

Name of Surveyor___________________
Date___________________
Time___________________
1. City Profile

Name of the city___________________

Geographic location of the city___________________
Area of the city___________________
Location of the terminals with its connectivity.
 Airport___________________
 Railway station___________________
 Bus stand___________________

 Land Use Distribution

Land use Area (in hectares)
Residential
Commercial
Industrial
Public/ Semi Public
Circulation
Agriculture
Government land

 Population Distribution

Year Population Growth Rate

1991
2001
2011
2019

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Growth of Vehicles By Their Type

Year Two Auto Rickshaw Car/Jeep Mini Truck Animal drawn Growth Rate
wheelers Bus Vehicles
1991
2001
2011
2019

 Accident Survey

Years Number of Number of person Number of person List of black spots

Accidents killed Injured on Roads
2015
2016
2017
2018
2019

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 2. Road Inventory

Total Road Length of the City_____________

Width of the Road Number of Roads Carriageway Width (m) Connectivity Of Roads
(ROW) (In mtr) (Functions)

Existing proposals of the roads undergoing in the city____________________

Stretch Elements Width (m) Number of Divided/Undivide Remarks
lanes* d (Conditions*)
Right-of-way
Carriage way
Kerb
Shoulder/
kacha path
Cambers
Side slope
Cycle track
Footpath
Median
Service lane
Green belt

Name of Road Length in KMS Design Speed Design Capacity of road

 Intersection Details
 Name of the road_____________
Name of Leng Width Hight Availabilit Entry Exit Approachin Width Of
Intersection th y Angle Angle g Turning
(Yes/No) width
T-Junction
Y-Junction
Staggered
Junctions
Multi leg Junction
Cross Roads
Scissors
Junction
*Type of Intersection: T-Junction, staggered Junction, X- Junction, Y- Junction, Rotary inters

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 Road Side Infrastructure
Name of the road _____________Stretch Form _____________to_____________

Infrastructure Availability Number Design As per Not As Per Remark

(Yes/No) Location Shape And size colour Standards Standards (Condi
Traffic Lights
Signs
Roads Markings
Roadway
Delineators
Hazard Markets
And Object
Markets
Barricades
Traffic Aid Post
Speed Breakers
And Rumble
Strips
Safety Barriers
Railings
Street Lights
Traffic
Attenuators
Tree Guards
Road Side Rest
Area
Road Side Toilets

Bus Stops
Taxi Stands

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 3. Traffic Characteristics

TRAFFIC VOLUME SURVEY

Name of the road_____________
Date:
Cordon Point Number _____________Sketch:
From : ______________To: _______________ Movement Recorded: _______________
Duration Of Survey: _____________

Public Transport Private Transport Goods Transport

T Two Min Auto Mata Cycle Car/ Motorcy Truck Tract Animal
i wheel i ricksha Dor ricksha Jeep cle or and Drawn
m ers Bus w w trailer Vehicles
e

 Speed Survey
Name of the Road_____________
Mode of Transport_____________
Date_____________
Time_____________

Stretch Starting Time Ending Time Distance

From To

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 Delay Survey
Name of the Road_____________ Mode of Transport_____________
Date_____________ Time_____________

Stretch Spot and Starting Time Ending Time Duration or Remarks

location delay
From To

Name of the Road_____________

Stretch: From_____________ To _____________
Time_____________

Black Number of Number of Number of Cause Nature Type of Time and

spot accidents person person area Light
Name killed Injured Conditions

 Parking Inventory
Name of the Road_____________
Spot Category of Lot area Location Area Parking Parking Capacity of
parking Charges Pattern Lot

Parking Characteristics:

 On Street Parking: Yes / No_____________

On Street Parking Orthorised /Unauthorized Planned / Unplanned Off Street Parking

Yes No Yes No

Human Behavior/Traffic Violations

Name of the Road: _____________

Stretch: From _____________To: _____________

Date_____________

Time_____________

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Spot Violations Mode of Vehicle Number of Remarks
(Intersection) doing Vehicles
Violations*
Red Light Jump

Lane Violations

Speeding

Pedestrian
Crossing
Violations

Neglen Driving

*Mode of Vehicle doing Violations: Car, 2-wheeler, Auto, Truck, Trolley, Bus, Animal Drawn
Cart

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 4. Traffic Control and Regulation Devices:

• Road Safety Signs

Name of the road: _____________
Date: _____________
Time: _____________
Stretch: From: _____________ to: _____________
Spot and Type of Availability Design Remarks
Name Siign (Yes/No) (Condition)
Location Shape Visability
and Size and
Placement colour

• Traffic Signals
Name of the road: _____________

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Date: _____________ Time _____________

Stretch: From _____________to: _____________

Spot" Type of Availability Functions Remarks

And signs (Yes/No)
name
Height Visibility
And
Placement

 Road Marking
Name of the Road_____________

Stretch: From: _____________to

Date: _____________ Time _____________
Spot Component Availability Designs Remarks
and (Yes/No)
name Length and Shape and Visibility and
Width colour Brightness
Centre Line
Traffic Lane
Line
No Overtaking
Line
Warning Line
Bus/truck Lane
Stop Line lane
Footpaths
Pedestrian
Crossing
Parking Lane
Cycle Track

 Traffic Calming Measures

Name of the road: _____________
Stretch: From: _____________ To: _____________

Spo Component Avail Design Remark

t ability s
and (Yes/
Na No)
me
Shape Length Widt Colour High Angl Turning Visibili
h t e Radii ty
Rumble Strips
Speed
Breakers

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 Speed
Cushions
Acceleration
Lane
Deacceleration
lane

Police
barricades and
Channerlisers
Railings
Service lane
Speed tables
Bus bay
Truck bay
Spot: Intersection, Length, Width and Colour: As per standard, Not as per standard
Visibility: Clearly visible, Partially visible with obstruction by tree, hoarding etc, No Visibility
Condition (Broken, Fading of colours, Missing Lines, Lines present but not utilized)

• Physical Barriers
Name of the road: _____________
Stretch: From: _____________ to: _____________

Sr. No. Spot and Location Type of Barrier Number

Spot: Intersection, Mid-Block

Type of Barrier: Historical Building, Monuments, Church, Temple, Trees, Pillars, Railings

5. Abutting Land Use and Encroachment

• Abutting Land Use Survey

Name of the road: _____________
Stretch: From: _____________ To: _____________
Side: Left/Right_____________
Building G G+1 G+2 G+3
Number

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• Encroachment Survey
Name of the road: _____________
Date: Time: Stretch: From: _____________ To: _____________
Spot Type of Length of Width of Effective Rod Reason for
Encroachmen Encroachment Encroachment Width Encroachment
t

Type of Encroachment: On-street parking, Informal Sector, Physical barrier, On street parking
Informal sector and Physical barriers, No encroachment

• Public Opinion
Name of the road/intersection: _____________ Stretch: From: _____________ To: __________
Date: _____________ Time: _____________
1. Are you aware of the traffic signs or the information they are providing?
Yes ( ) No ( )
2. How often you see and follow the signs? Always
Sometimes ( ) Never ( )
3. Are you aware of the markings on road?
 Centre Line: Yes/No_____________
 Traffic Lane Line: Yes/No_____________
 No overtaking line: Yes/No_____________
 Warning Line: Yes/No_____________
 Bus/truck Lane: Yes/No_____________
 Stop Line: Yes/No_____________
 Footpath line: Yes/No _____________
 Parking Line: Yes/No _____________
 Pedestrian Crossing line: Yes/No _____________
 Cycle track marking: Yes/No_____________
4. How often follow the markings?

Always ( ) Sometimes ( ) Never ( )

5. How often and why you jump the red light or other signals?
Always ( ) Sometimes ( ) Never ( )

Reasons: _____________

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6. How often and why you violate the lane?? Always
Always ( ) Sometimes ( ) Never ( )
Reasons: _____________

7. How often you violate the stop line and stop vehicle at pedestrian crossing?
Always ( ) Sometimes ( ) Never ( )
Reasons: _____________

8. How often or why not you use the pedestrian crossing for the crossing of road?
Always ( ) Sometimes ( ) Never ( )
Reasons: _____________

9. How often you wear the helmet? Always

Always ( ) Sometimes ( ) Never ( )
Reasons: _____________

10. How often and why not you and the pillon rider wear the seatbelt?

Always ( ) Sometimes ( ) Never ( )

Reasons: _____________

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