Required fields are marked with asterisks (*)

School Traffic Safety Site Inspection Request

Purpose:

The Burlington School Site Inspection Request form is to identify, school traffic and mobility-related risks, in and around school areas. The form information will be given to the Burlington School Traffic Safety and Mobility Advisory Committee which will provide recommendations to staff on school traffic and mobility-related issues.

Notice of Collection:

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25, as amended, to communicate with you regarding your inquiry. Questions about this collection can be directed to the Supervisor, School Crossing Guards, Transportation, City of Burlington, 426 Brant Street, Burlington, Ontario, L7R 3Z6, 905-335-7777, E: bryan.letourneau@burlington.ca

Site Inspection

Requested by:

Resident

School Administrator

Other

Name:

Date of incident or issue seen:

Address:

Phone:

Email:

Name of school/intersection:

Reason(s) for request- check all that apply:

Park and Ride

Traffic congestion on school property

Traffic congestion on school street

Parking issues

Crossing guard injury

Other

Observations: Note: be specific – include date, time, location, etc.

If you would like to include photos, drawings, diagrams, etc., please attach.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Have you informed anyone about this issue?

Yes

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School Traffic Safety Site Inspection Request

Purpose:

Notice of Collection:

Site Inspection