Streetsafe - Address Survey Form

1. Address (Name & Phone Number Optional) Required Question

2. Property type

	Privately Owned
	Rented Private
	Rented Local Authority
	Landlord details

COMMUNITY POLICING

3. What do you consider to be your number one local community problem ?

4. How does this affect your behaviour/routines?

5. How often are you affected by the above problem ?

6. What do you consider to be the best thing about living in this area?

7. Do you know who is your local Community Police Officer?

	Yes
	No

ROAD SAFETY

8. Is there a problem in this area in relation to speeding vehicles?

	Yes
	No

9. If yes – Brief details

10. Do you have any other concerns in relation to road safety in this area?

	Yes
	No

11. If yes – Brief details

CRIME PREVENTION

12. If you send us an email, we may be able to supply you with a free UV Pen. Do you know how to mark your property?

	Yes
	No

13. Has you property been marked by an officer with UV pen?

	Yes
	No

14. Details

COMMUNITY ISSUES

15. Are there any abandoned or untaxed vehicles in your community which require removal?

	Yes
	No

16. If yes – Brief details

17. Are there any problems with the footpaths in this area?

	Yes
	No

18. If yes – Brief details

19. Are there any problems with the street lighting in this area?

	Yes
	No

20. If yes – Brief details

FIRE SAFETY / SMOKE KILLS

21. Do you have a smoke alarm fitted?

	Yes
	No

22. If yes: Does the alarm work?

	Yes
	No

23. If yes: Was it tested by officer?

	Yes
	No

24. If no: Would you like one fitting free of charge?

	Yes
	No

25. Would you like a free fire survey?

	Yes
	No

ANTI-SOCIAL BEHAVIOUR

26. Are there any problems in this area in relation to drug-related issues?

	Yes
	No

27. If yes – Brief details

28. Are there any problems in this area in relation to litter or fly-tipping?

	Yes
	No

29. If yes – Brief details

30. Are there any problems in this area in relation to graffiti?

	Yes
	No

31. If yes – Brief details

32. Are there any problems in this area in relation to dog fouling?

	Yes
	No

33. If yes – Brief details

34. Are there any problems in this area in relation to youth disorder?

	Yes
	No

35. If yes – Brief details

CDRP / NEIGHBOURHOOD WATCH / COMMUNITY GROUPS

36. Have you heard of the Crime & Disorder Reduction Partnership?
(A group of local organisations including the Police, local councils, Probation Service, schools, voluntary and business organisations working together to reduce crime in the area)

	Yes
	No

37. Are you involved in a Neighbourhood Watch scheme or Community Group?

	Yes
	No

38. If yes, which one?

39. Would you be interested in setting up / being involved with a local community group?

	Yes
	No

40. Would you like to receive more information on CDRP, Neighbourhood Watch or local Community Groups?

	Yes
	No

41. If yes, which ones?