Did you see people with obvious physical disabilities, such as those using walkers or wheelchairs? ☐
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Did you see those with apparent mental or emotional disabilities? ☐
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Did you observe people smoking tobacco products? ☐
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Did you observe people who appear to be under the influence of drugs or alcohol? ☐
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Did you see pregnant women? ☐
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Did you see pregnant adolescents? ☐
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Did you see young women or men with strollers or young children? ☐
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Answer the following questions using complete sentences.
What was the approximate age range of the people you saw (youngest to oldest):
Describe the general appearance of those you observed (thin, obese, fit, undernourished, etc.):
Describe the dress of those you observed (unkempt, torn, appropriate, well-dressed, etc.):
Briefly describe what the people you observed were doing (driving, exercising, socializing, etc.):
Were any areas undergoing renewal? ☐
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Was public housing observed? ☐
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Was there public transit? ☐
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Were there bus stops? ☐
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Was transportation to health care resources observed? ☐
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Were there job opportunities nearby, such as factories, small businesses, or military installations? ☐
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Were there unemployed people visible, such as homeless people? ☐
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Did you see people congregating in groups on the street? ☐
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Did you note any seasonal workers, such as migrant or day laborers? ☐
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Did you observe any children or adolescents out of school during the typical school hours? ☐
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Did you observe any political signs? ☐
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Do you see any evidence of health education on billboards, advertisements, or signs? ☐
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Answer the following questions using complete sentences.
What kinds of housing did you observe (detached homes, apartments, etc.)?
Describe the general condition of the housing you observed:
Describe the forms of transportation you saw people using:
Describe the main types of work you observed that were available to residents?
What kinds of schools and day care centers were observed?
Do these resources seem sufficient to address the kinds of problems that exist in this community?
Did you observe poor road conditions with potholes, or poor drainage? ☐
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Are there adequate traffic lights, signs, sidewalks, and curbs? ☐
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Are railroad crossings fitted with warnings and barriers? Are streets and parking lots well lit? ☐
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Was there handicapped access to buildings, sidewalks, and streets? ☐
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Did you observe recreational facilities, playgrounds, and/or facilities like the YMCA? ☐
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Were recreational facilities being used? ☐
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Were children playing in the streets, alleys, yards, or parks? ☐
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Did you see any restaurants? ☐
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Was there any evidence of nuisances such as ants, flies, mosquitoes, or rodents, or stray animals observed? ☐
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How many churches, synagogues, and other places of worship did you observe? ☐
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Answer the following questions using complete sentences.
Describe the general types of churches, synagogues, and other places of worship you observed.
Describe interactions observed among family or friends during survey. Is more than one generation present?
Were children out playing and if so were they appropriately supervised?
Were there any identifiable subgroups either of people socially or geographically?
Describe evidence of community cohesiveness that you observed (such as signs of a neighborhood watch or other social events or clubs).
Describe any observations that made you suspicious of social problems, such as graffiti, evidence of gang activity, juvenile delinquency, or drug or alcohol abuse?
Did you observe that health resources were underutilized? ☐
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Was there evidence of preventive or wellness care? ☐
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Did you observe any efforts to improve the neighborhood’s health such as advertisements for health-related events, health fares, clinics, or lectures? ☐
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☐ Adolescents
☐ Recent immigrants
☐ Seniors
☐ Migrant Workers
☐ Those living in poverty
☐ Those affected by mental illness
☐ Those who are homeless
☐ Disadvantaged ethnic groups
Answer the following question using complete sentences.
Thoroughly describe what you observed about one aggregate or vulnerable group that you identified above (i.e. gender, behavior, age, appearance, etc.):
Describe unhealthy behaviors that you observed during your survey:
Describe health problems you observed during your survey or potential health problems that you would anticipate based on your observations:
Picture 2
References
Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion: Healthy People 2020. (2019). Objectives. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/