ACTIVE TRAVEL
WALKING QUESTIONNAIRE
1. Which town are you responding in relation to? (please tick only one – if you wish to
provide information for more than one, please use a separate form)

Aberystwyth
 Cardigan & St Dogmaels (please note all matters in relation to St Dogmaels will be
forwarded to Pembrokeshire County Council).
 Lampeter

2. Please list any regular journeys you make (by any means) in or near this town (e.g.
home to work).
Starting point (postcode/street)
Destination (postcode/street)
3. Please indicate how often you walk to the following locations in or near this town:
(please tick only one box for each row)
Daily
Work
School/college
Shopping
Social visits
Leisure
Health
appointments






2-3 times
per week






Weekly






2-3 times
per month






Monthly





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Less often
or never






4. Do you use shared routes (i.e. with cyclists)?
 Yes, often
 Yes, sometimes
 No, never
5. How satisfied would you say you are with current facilities for walking in or near the
town?





Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
6. What is the main reason you do not walk within, or in the vicinity of, this town? (please
tick only one)






Health
Routes not suitable
Time constraints
Weather inclement
Fitness
Other (please specify: ………………………………………………………………………)
7. Are there changes that we could make that would encourage you to walk more within,
or in the vicinity of, this town? (please tick only one)
 Yes
 No
8. If yes, please tell us what you think the three most effective changes would be:
1.
2.
3.
Integrated Network Map
Please have a look at the map for the town you are responding about.
9. Which routes would you like to see introduced or improved?
Further Contact
10. Would you be happy for us to contact you to discuss any points you have raised?


Yes
No
11. If yes, please provide your contact details below (including name, address, telephone
number and/or email address)
About you
You are being asked the following information for equalities monitoring – it will be used for
statistical purposes only. All the information you provide will be treated confidentially and
handled in accordance with the Data Protection Act 1998.
1. Age: What is your age group?
Under 16

45 – 64 years

16 – 24 years

65+

25 – 44 years

Prefer not to say

2. Gender: What is your gender?
Male

Female

Other

Prefer Not To Say

3. Transgender: Is your gender the same now as when assigned at birth?
Yes

No

Prefer not to say

4. Sexual Orientation: Which of the following options best describes how you think of
yourself?
Heterosexual/Straight

Bisexual

Gay Man

Prefer not to say

Gay Woman/Lesbian

Other (state if desired) _______________________

Note: This question should only be asked of people age over 16.
5. Partnership: Which of the following options describes your partnership status?
Single

Widowed

Married

Civil Partnership

Living with Partner

Separated

Divorced

Other

Prefer not to say

6. National identity: How would you describe your national identity?
Welsh

British

English

Irish

Scottish


Prefer not to say

Northern Irish
Other (please describe)
_____________________________________
7. Race: What is your ethnic group? Choose one option that best describes your ethnic group
or background.
White

Gypsy Travellers

Asian

Prefer not to say

Black/African/Caribbean

Other (Please State)
Mixed

______________________________________
8. Language: What is your preferred language?
Welsh
English

Prefer not to say


Other (including British Sign Language)
______________________________________________
Can you understand, speak, read or write Welsh?
Write Welsh
Speak Welsh


None of the above


Read Welsh

Prefer not to say

Understand spoken Welsh
9. Disability: Do you have a long term physical or mental health condition or illness that
reduces your ability to carry out day to day activities
Yes
No



Prefer not to say
If you answered ‘Yes’ please indicate which applies to you:




Hearing Impairment
Visual Impairment
Speech Impairment
Learning Difficulties



Mental Health Issues
Physical / Mobility Impairment
Prefer not to say
Other (please specify)
______________________________________
10. Caring Responsibilities: Do you look after or give help or support to family
members, friends, neighbours or others because of either:
 Long term physical or mental ill-health/disability; or
 Problems related to old age
Yes
No


Prefer not to say

11. Religion or Belief: What is your religion?
Christian (all denominations)

Jewish

Buddhist

Atheist

Hindu

No religion

Muslim

Prefer not to say

Sikh

Other

Your help is much appreciated
Thank you for your time
The closing date for responses is 3rd March 2017.
Please respond to: [email protected] or Traffic Section, Ceredigion County
Council, County Hall, Market Street, Aberaeron, SA46 0AT.