Rest Area Report Card

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* 1. Date and Time:

Date & Time:

Date

Time

AM/PM

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* 2. Rest Area Location:

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* 3. Rate the following at this rest area:

	Poor	Average	Excellent
Parking Lots	Parking Lots Poor	Parking Lots Average	Parking Lots Excellent
Rest Rooms	Rest Rooms Poor	Rest Rooms Average	Rest Rooms Excellent
Grounds	Grounds Poor	Grounds Average	Grounds Excellent
Picnic Facilities	Picnic Facilities Poor	Picnic Facilities Average	Picnic Facilities Excellent
Lighting	Lighting Poor	Lighting Average	Lighting Excellent
Vending	Vending Poor	Vending Average	Vending Excellent
Sidewalks	Sidewalks Poor	Sidewalks Average	Sidewalks Excellent
Overall	Overall Poor	Overall Average	Overall Excellent

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* 4. Would you like to see the following at this site:

	Yes	No	Waste of Money
Wireless internet	Wireless internet Yes	Wireless internet No	Wireless internet Waste of Money
Weather information	Weather information Yes	Weather information No	Weather information Waste of Money
Travel information	Travel information Yes	Travel information No	Travel information Waste of Money
Tourist information	Tourist information Yes	Tourist information No	Tourist information Waste of Money

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* 5. How many minutes were spent in the rest area?

0-5 minutes

5-15 minutes

15-30 minutes

30 minutes or more

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* 6. Was the Rest Area:

	Yes	No
Clean	Clean Yes	Clean No
Safe	Safe Yes	Safe No
Convenient	Convenient Yes	Convenient No

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* 7. I'm driving:

Car/Pickup

RV

Semi

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* 8. Thank you for taking our survey. You may list any additional comments below:

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* 9. Contact Information(optional):

Name:

Address:

Email Address:

Phone Number: