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OCR for page 102
102 APPENDIX A Subject Data Collection Forms Circle the letter grade that most represents your perceived service. A = highest rating F = lowest rating Please view the entire video clip before selecting a rating. Pedestrian Presentation Clip Number Perceived Service Rating Practice Clip #212 A B C D E F #201 A B C D E F #226 A B C D E F #225 A B C D E F #208 A B C D E F #219 A B C D E F #228 A B C D E F #211 A B C D E F #215 A B C D E F #229 A B C D E F #222 A B C D E F

OCR for page 102
103 Circle the letter grade that most represents your perceived service. A = highest rating F = lowest rating Please view the entire video clip before selecting a rating. Bicycle Presentation Clip Number Perceived Service Rating Practice Clip #326 A B C D E F #319 A B C D E F #308 A B C D E F #306 A B C D E F #309 A B C D E F #320 A B C D E F #318 A B C D E F #304 A B C D E F #324 A B C D E F #321 A B C D E F #329 A B C D E F Circle the letter grade that most represents your perceived service. A = highest rating F = lowest rating Please view the entire video clip before selecting a rating. Automobile Presentation Clip Number Perceived Service Rating Practice Clip #5 A B C D E F #20 A B C D E F #56 A B C D E F #10 A B C D E F #51 A B C D E F #14 A B C D E F #2 A B C D E F #62 A B C D E F #63 A B C D E F #52 A B C D E F #15 A B C D E F

OCR for page 102
104 Please circle the choice which best describes your characteristics. 1. Your age group: 18-35 years of age 36-60 years of age 60 and up years of age 2. Gender: Male Female 3. Number of vehicles in your household: 0 1 2 3 or more 4. Number of bicycles in your household: 0 1 2 3 or more 5. Employment status: Employed Unemployed Homemaker Retired 6. Your primary residence is: A. Single-family detached home B. Apartment/duplex/townhouse/condominium C. Group quarters such as a college dormitory or independent living facility D. Other, please specify: ________________ 7. Do you rent or own your home? A. Rent B. Own 8. What is your primary residence/home zip code? ______________ 9. If you are currently employed, what is your workplace zip code (or city of location): __________________________ 10. How often do you walk more than two blocks a week for a non-recreational trip (for example, walk to work, walk to school, walk to a store)? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 11. How often do you walk more than two blocks a week for a recreational trip or for exercise ? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 12. How often do you use a bicycle for a non-recreational trip (for example, ride a bike to work, ride a bike to a store)? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 13. How often do you use a bicycle outside of a gym for a recreational trip or for exercise ? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 14. How often do you use transit (bus, subway, train)? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 15. How often do you use a car? A. Never B. Less than once a month C. About once a week D. More than once a week but not every day E. At least once a day 16..What is your usual means of travel to work? A. Auto, drive alone B. Auto, carpool C. Transit (bus, train, ferry or other) D. Walk E. Bike F. Other: ________________________