Vision Zero Story Request 2

Vision Zero - Communications with People Impacted by Car Crashes

Austin Transportation is working to achieve our community's Vision Zero goal of zero deaths and serious injuries from car crashes on our roadways. Effectively communicating that all members of the public must individually practice safe driving behaviors to share responsibility in keeping our roadways safe is one of the most important aspects of the program.

Sharing real stories from real people impacted by traffic crashes in our community can be one of the most effective ways to communicate that it is our friends and neighbors being killed and injured from preventable crashes, and that Vision Zero is not just a number. It is about people.

Please fill out the following form if you're willing to share your story, and help the Vision Zero program reach more people with this important message. The team will be in touch soon to talk about your desired level of participation before anything is shared publicly.

Thank you.

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* 1. Contact

Name(s)

Email Address

Phone Number

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* 2. Name of the person(s) in the crash and relationship to you

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* 3. Mode of travel of the victim

Motor Vehicle

Bicycle

Scooter

Pedestrian/Walking

Motorcycle

Other (please specify)

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* 4. Location of the crash (specific streets preferred)

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* 5. What could have affected the outcome of the crash? (Was the driver speeding? Driving distracted? Intoxicated? etc.)

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* 6. Which of the following best represents your cultural identity?

White

Hispanic and/or Latinx

Asian

Black and/or African-American

American Indian and/or Alaska Native

Native Hawaiian and/or Pacific Islander

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* 7. Which of the following best represents your gender identity?

Female

Male

Another gender

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* 8. Do you identify as someone with a disability?

No, I do not identify as having a disability

Yes, I have a mobility-related disability

Yes, I have a cognitive- of intellectually-related disability

Yes, I have a hearing-related disability

Yes, I have a vision-related disability

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* 9. What is your age?

15 - 24 years old

25 - 34 years old

35 - 44 years old

45 - 54 years old

55 - 64 years old

65+ years old

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* 10. What is your yearly household income?

$0 - $24,999

$25,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000+

Thank you for sharing your story. The team will be in touch soon to work with you and discuss how you would like to be involved in the Vision Zero marketing campaign before anything is shared publicly. Please note that some stories may not fit the nature of this new campaign and/or may be saved for later use.