Survey

Multipage

This is a web-based form survey. Please give your best answer for each question.
1 Enter the ONE that BEST describes your assigned work schedule at THIS worksite.
2 Enter your typical start time and end time. (If times vary, enter your average start time/end time) Example: 6:30 pm

Start

End

3 On average, how many days do you use each of these modes to get to this employer's worksite? If you use more than one mode each morning, select the mode that represents the longest portion of your commute. Do not include trip home.

* Telework/Virtual Office means working a scheduled FULL DAY at home for this employer, instead of driving to a worksite.

days per week
days per week
days per week
days per week
days per week
days per week
days per week
days per week
days per week
4 Answer this question ONLY - if the vehicle you typically use to commute to this worksite uses one of the Alternate Fuel types listed below.
5 You have selected that you ride in a carpool and/or a vanpool in question #3, how many other people (age 16 or older) travel with you?
6 How many miles (one-way) is it from your home to this worksite?

Virtual Office workers, indicate the number of miles you would have driven if you didn't work at home.

Miles
7 How many minutes (one-way) does it usually take you to travel from home to this worksite?
Minutes
8 If you were willing to make a change to your daily commute, which options interest you the most? (select all that apply)
9 What would motivate you to use an alternative mode? (select all that apply)
10 Are you:
11 What is your age?
12 In what city do you live?
13 What is your home zip code?
14 What are the two (2) major cross streets closest to your home?
example:
15 Do your work activities generally include managerial responsibilities?
16 Select the ONE that BEST describes your primary work activity on a regular basis
17 Optional comments:
For admin use only.