External Auto Travel Survey Form

 Survey Date  (mm/dd/yyyy)     Time (24 HR)  0800090010001100120013001400150016001700   Location 

                                                                                                                    Direction  Inbound  Outbound

 SURVEY NUMBER     (Enter the number from the TOP LEFT Corner of the form. REQUIRED )

1.  Where did THIS trip begin ?  (Give full street address, nearest street intersection, name of company or building)

   Address        

   Community      State  

2.  Where did THIS trip end ?  (Give full street address, nearest street intersection, name of company or building)

     Address      

     Community     State 

3.  I came from:                  01 Home02 Place of Work03 Work-connected business04 Shopping05 Personal business, medical/dental06 School07 Social/recreational08 Pick up and or drop off passenger(s)09 Other

     IF OTHER, Please Specify 

4.  I was going to:                01 Home02 Place of Work03 Work-connected business04 Shopping05 Personal business, medical/dental06 School07 Social/recreational08 Pick up and or drop off passenger(s)09 Other   

    IF OTHER, Please Specify 

If this trip started and ended outside of the Southeastern Wisconsin region (defined as the counties of Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington and Waukesha), pleas answer the following 2 questions.

5.  What road did you use to enter the Region ?     

6.  What road did you use to leave the Region ?   

7.  Where is this vehicle usually garaged or parked overnight ? (Give full street address or nearest street intersection)

     Address      

     Community     State 

8.  Vehicle type: 1 Passenger car2 Passenger car with camper3 Passenger car with boat4 Taxi5 Motorcycle

9.  The number of vehicle occupants, including the driver, on this trip was ?  

Thank you.

Thank you for your cooperation.

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