Community Health Survey Tool

Nurses must be able to knowledgeably plan services for individuals, families and the community. In
order to effectively plan, it is essential that you are aware of the resources specific to the community a
client resides in to allow for identification of health-related resources and to understand gaps in
services. A community health survey is conducted from a car or through a stroll in the neighbor and
provides a visual overview of a community. Conditions and trends in the community that could affect
the health of the population should be noted. This data provides background and context for working
with individuals and families in their community.

Student:

Date and time survey was performed:

Weather conditions:

Type of Survey: (Walking or Windshield)

Town Accessed:

Boundaries Observations
Are the boundaries geographical,
political, or economic?
Do neighborhoods have names?
Are there sub-communities?
How are these identified?

Housing and Zoning

What is the age of the buildings?
Are the residences single family or
multifamily dwellings?

Signs of Decay
Is the area well maintained or in
disrepair? Is there garbage strewn?
Are there trashed/abandoned cars,
places for rodents or other wildlife
to hide, vacant lots?
Parks and Recreational Areas
Are there play areas for children
and adults? Are they safe and
maintained? Is there a Community
Center? Who uses them?

Common Areas
Where do people collect for social
gatherings; where do they “hang
out”? Are they for particular groups
or are they open to all? Are there
signs posted?

Stores
What stores (grocery, retail, drug,
dry cleaning, etc.) are in the area?
How do residents travel to them?

Transportation
How do most people get around
the area? Is there public
transportation? If so what kind and
does it appear to be used? Who
uses it? What is the condition of
the streets, roads, highways?

Infrastructure:
What is the condition of roads,
bridges, sidewalks, etc.? Are there
differences in these conditions
from one area of the community to
another? Do all parts of the
community seem to be equally
served by electricity, water, phone,
fiber optic, wastewater treatment,
waste disposal, and other
infrastructure services?

Commercial Use:
What kinds of businesses are
there? Are there boarded-up or
vacant storefronts? Is there a mix
of large and small businesses? Are
there grocery stores and
supermarkets, pharmacies, and
other stores that provide
necessities in all parts of the
community?

Industry:
What kinds of industry exist in the
community? Does it seem to be
causing pollution?

Communication
Is there evidence of local and
national newspapers to other
media? Are there informational
posters on streets, busses,
billboards, etc.?

Service Centers
What services are available in the
community – health care, social
services, schools, employment
offices etc.?

Health Services:
How many hospitals and clinics are
there in the community? Where
are they located? How big are
they? How easy are they to get to?

Community and Public Services:

Are there identifiable community
service providers and organizations
in the community – mental health
centers, food banks, homeless
shelters, welfare offices, etc.? Are
they concentrated in a particular
area? Are they easy to reach by
public transportation?

People in the Community

Who is in the area during the day?
What evidence is thereof particular
“classes” of people – upper,
middle, working, lower?

Industries
What are the major industries
located in the area? What types of
occupations are evident?

Land Use:
How much open space is there?
How are residential, commercial,
and industrial areas distributed? Do
major roads or railroad tracks
divide neighborhoods, or are they
on the edges of the community?

Protective Services
Where are fire and police stations
located? Is there evidence of police
and fire protection in the area?

Ethnicity
What is the predominant ethnic
group? Are there residents from a
variety of ethnic backgrounds or is
the community mostly one group?
Which one? Are there stores,
restaurants, churches, schools, or
languages that indicate a particular
ethnic group(s)?

Religion
What churches and church-run
schools are in the area
(denomination)? How many are
there of each denomination?

Health and Morbity

Is there evidence of any health
problems such as drug/alcohol
abuse, communicable or chronic
diseases, mental illness (etc)?

Politics
Is there evidence of political
activity? Are there any signs that
indicate a predominant political
party (parties)or concern(s)?

Community Safety:
Where are police and fire stations
located? Are they in good repair? Is
the community well-lit at night?

Higher Education:

Are there two- and four-year

colleges and/or universities in the
community? Where are they
located? Do they seem open to the
community, or do they seem self-
contained and isolated?

Public Schools:

Are schools in different

neighborhoods in noticeably
different states of repair? Are
schools well maintained? Or in
some developing countries, are
there schools in the community at
all?

What are the differences among

different parts of the community?
Are schools, stores, public and
other buildings, streets, etc. in
different areas in different
condition? Do some areas seem
neglected, while others are clearly
maintained?

The “feel” of the community. What

is your overall impression of the
community?