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NorthEast Neighbors Sidewalk Survey
Please fill out as much information as you can.
* These questions require responses
Name
*
First
Last
Email
*
Address of Sidewalk
*
Have you reported this location
to the city?
*
Yes
No
If YES, when?
MM
/
DD
/
YYYY
Have you ever been injured on a city sidewalk?
*
Yes
No
If YES, when?
MM
/
DD
/
YYYY
If you have been injured,
did you report it to the city?
*
Yes
No
If YES, when?
MM
/
DD
/
YYYY
Have you filed an ADA complaint
for this location?
*
Yes
No
If YES, when?
MM
/
DD
/
YYYY
Additional Information
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